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

ELECTROCARDIOGRAM 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., 1960Electrocardiogram: 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: 0-597-84405-4 1. Electrocardiogram-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 electrocardiogram. 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 ELECTROCARDIOGRAM............................................................................. 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Electrocardiogram ....................................................................... 10 E-Journals: PubMed Central ....................................................................................................... 26 The National Library of Medicine: PubMed ................................................................................ 27 CHAPTER 2. NUTRITION AND ELECTROCARDIOGRAM ................................................................... 35 Overview...................................................................................................................................... 35 Finding Nutrition Studies on Electrocardiogram........................................................................ 35 Federal Resources on Nutrition ................................................................................................... 38 Additional Web Resources ........................................................................................................... 38 CHAPTER 3. ALTERNATIVE MEDICINE AND ELECTROCARDIOGRAM ............................................ 41 Overview...................................................................................................................................... 41 National Center for Complementary and Alternative Medicine.................................................. 41 Additional Web Resources ........................................................................................................... 42 General References ....................................................................................................................... 44 CHAPTER 4. DISSERTATIONS ON ELECTROCARDIOGRAM .............................................................. 45 Overview...................................................................................................................................... 45 Dissertations on Electrocardiogram............................................................................................. 45 Keeping Current .......................................................................................................................... 45 CHAPTER 5. PATENTS ON ELECTROCARDIOGRAM ......................................................................... 47 Overview...................................................................................................................................... 47 Patents on Electrocardiogram ...................................................................................................... 47 Patent Applications on Electrocardiogram .................................................................................. 73 Keeping Current ........................................................................................................................ 107 CHAPTER 6. BOOKS ON ELECTROCARDIOGRAM ........................................................................... 109 Overview.................................................................................................................................... 109 Book Summaries: Online Booksellers......................................................................................... 109 Chapters on Electrocardiogram.................................................................................................. 112 CHAPTER 7. PERIODICALS AND NEWS ON ELECTROCARDIOGRAM ............................................. 115 Overview.................................................................................................................................... 115 News Services and Press Releases.............................................................................................. 115 Newsletter Articles .................................................................................................................... 117 Academic Periodicals covering Electrocardiogram .................................................................... 117 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 121 Overview.................................................................................................................................... 121 NIH Guidelines.......................................................................................................................... 121 NIH Databases........................................................................................................................... 123 Other Commercial Databases..................................................................................................... 125 APPENDIX B. PATIENT RESOURCES ............................................................................................... 127 Overview.................................................................................................................................... 127 Patient Guideline Sources.......................................................................................................... 127 Finding Associations.................................................................................................................. 129 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 131 Overview.................................................................................................................................... 131 Preparation................................................................................................................................. 131 Finding a Local Medical Library................................................................................................ 131 Medical Libraries in the U.S. and Canada ................................................................................. 131 ONLINE GLOSSARIES................................................................................................................ 137

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Online Dictionary Directories ................................................................................................... 137 ELECTROCARDIOGRAM DICTIONARY .............................................................................. 139 INDEX .............................................................................................................................................. 189

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

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

Prevalence of Q-T Interval Dispersion in Type 1 Diabetes and Its Relation with Cardiac Ischemia Source: Diabetes Care. 25(4): 702-707. April 2002. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: A measurement taken during electrocardiogram (ECG) testing, the Q-T interval, has been shown to predict mortality (death) in patients with type 2 diabetes. A prolonged Q-T interval is associated with sudden death and poor survival in healthy subjects and in a variety of clinical conditions, including newly diagnosed type 2 diabetes, nephropathy (kidney disease), and type 1 diabetes. This article evaluated the

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prevalence of Q-T interval dispersion (QTd) prolongation in the EURODIAB population and its relation to corrected Q-T interval (QTc), sex, age, duration of diabetes, blood glucose control, and complications. A total of 3,042 patients with type 1 diabetes were studied. The prevalence of an increased QTd was 7 percent. A significant relation was observed between QTd prolongation and diastolic blood pressure. A higher prevalence of QTd prolongation was observed in patients with ischemic (lack of blood flow) heart disease, whereas no relationship was observed with retinopathy (eye disease), albumin (protein) excretion rate, or measures of somatic and autonomic neuropathy (nerve disease). Although QTd is statistically related to duration of QTc, increased QTd and increased QTc identify different patients, and their prediction value deserves prospective evaluation. 3 tables. 38 references. •

Left Ventricular hypertrophy is a Risk Factor Independent of Hypertension in Survival of Hemodialyzed Patients Source: Renal Failure. 24(2): 175-186. 2002. Contact: Available from Marcel Dekker Journals. P.O. Box 5017, Monticello, NY 127015176. (212) 696-9000. Summary: Hemodialysis patients have low 5 year survival rates of approximately 60 percent and the most common cause of death is cardiovascular diseases. Their population may be considered, therefore, as an accelerated model in analyzing the risk factors for cardiovascular disease. The authors of this article previously reported the role of blood pressure, one of the most important risk factors for cardiovascular disease, in determining the prognosis (likely outcome) of hemodialysis patients. In this article, the authors examined the effect of cardiomegaly (increase in size of the heart) detected before initiating hemodialysis therapy on survival after introduction to maintenance hemodialysis. The study included 160 hemodialysis patients who had no history of ischemic heart disease or arrhythmia; they were followed for up to 88.9 months (plus or minus 4.0 months) and 69 of these patients died during this time. Heart enlargement, defined on chest roentgenogram, was detected in 104 patients, and left ventricular hypertrophy (LVH), defined on electrocardiogram, was detected in 105 patients. The presence of either finding shortened the patient's survival. However, analysis identified only LVH as one of the significant determinants for survival. Correction of systolic hypertension (high blood pressure) on the maintenance phase had no significant favorable effect on survival in patients with LVH, while it improved in those with heart enlargement. 2 figures. 2 tables. 33 references.

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Basic Life Support and Emergency Cardiovascular Care Update, Part 3: Automated External Defibrillators Source: Dentistry Today. 20(11): 70-73. November 2001. Contact: Available from Dentistry Today Inc. 26 Park Street, Montclair, NJ 07042. (973) 783-3935. Summary: In instances of cardiac arrest (heart attack) and ventricular fibrillation (involuntary fluttering contractions of the heart that interrupt effective blood pumping), the time interval from onset of fibrillation to defibrillation is the most important determinant of survival. Automated external defibrillators (AEDs) have been designed to be user friendly so that the lay public can use them with basic life support (BLS) training. This article discusses the AEDs currently available and guidelines for their use. According the American Heart Association, a core training objective for a health care provider BLS course is the ability to show proficiency in the use of AEDs. The AED

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senses the patient's cardiac rhythm through a bandwidth amplifier, analyzing the electrocardiogram (ECG) signal for amplitude, frequency, and slope. Topics include using the AED, features of the AED, Heartstream AEDs, Medtronic physiocontrol AEDs, Survivalink AEDs, Medical Research Laboratories AEDs, and defibrillators versus AEDs. The author concludes that selecting an AED for the dental office is not an easy task. When purchasing a new AED, a biphasic waveform model now appears to be a better choice. However, of greater significance is the availability of a device in the dental office that will allow resuscitation to be accomplished. A posttest with which readers can obtain continuing education credit is appended to the article. 8 figures. 6 references. •

Long-term Safety of Tegaserod in Patients with Constipation-Predominant Irritable Bowel Syndrome Source: Alimentary Pharmacology and Therapeutics. 16(10): 1701-1708. October 2002. Contact: Available from Alimentary Pharmacology and Therapeutics. Blackwell Science Ltd., Osney Mead, Oxford OX2 OEL, UK. +44(0)1865 206206. Fax +44(0)1865 721205. Email: [email protected]. Website: www.blackwell-science.com. Summary: The oral administration of the drug tegaserod causes gastrointestinal (GI) effects resulting in increased gastrointestinal motility (movement of contents through the GI tract) and attenuation of visceral sensation. This article reports on a study undertaken to determine the long term safety and tolerability of tegaserod in patients with irritable bowel syndrome (IBS) with constipation as the predominant symptom of altered bowel habits. The multicenter, open label study included 579 patients. Of these, 304 (53 percent) completed the trial. The most common adverse events, classified as related to tegaserod for any dose, were mild and transient diarrhea (10.1 percent), headache (8.3 percent), abdominal pain (7.4 percent), and flatulence (5.5 percent). Forty serious adverse events were reported in 25 patients (4.4 percent of patients) leading to discontinuation in 6 patients. There was one serious adverse event, acute abdominal pain, classified as possibly related to tegaserod. There were no consistent differences in adverse events between patients previously exposed to tegaserod and those treated for the first time in this study. The authors conclude that tegaserod appears to be well tolerated in the treatment of patients with constipation-predominant IBS. The adverse event profile, clinical laboratory evaluations, vital signs, and electrocardiogram recordings revealed no evidence of any unexpected adverse events, and suggest that treatment is safe over a 12 month period. 1 figure. 4 tables. 23 references.

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Silent Myocardial Ischemia in Patients with Diabetes: Who to Screen Source: Diabetes Care. 22(9): 1396-1400. September 1999. Contact: Available from American Diabetes Association, Inc. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 806-7801. Website: www.diabetes.org. Summary: This article describes a 12-month cross sectional study that further defined a high risk population requiring screening by assessing the prevalence of angiographically documented silent myocardial ischemia (SMI) in a group of totally asymptomatic patients who had diabetes. Between May 1996 and April 1997, all patients who met the following criteria were asked to undergo screening for SMI: type 1 or type 2 diabetes, age between 20 and 75 years, absence of clinical or electrocardiogram (ECG) symptoms of coronary artery disease (CAD), duration of type 1 diabetes greater than 10 years for patients older than 40 years of age and greater than 15 years for patients younger than 40 years of age, and duration of type 2 diabetes with or without insulin treatment greater than 10 years for patients with no major cardiovascular risk factors or

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longer than 5 years for patients with at least one major cardiovascular risk factor. During the 1-year period, 203 patients were screened, including 28 women and 45 men who had type 1 diabetes and 61 women and 69 men who had type 2 diabetes. Exercise ECG was the first choice for screening method. If exercise ECG was not possible or inconclusive, thallium myocardial scintigraphy (TMS) with exercise testing or dipyridamole injection was performed. If any one of these tests was positive, coronary angiography was performed and was considered to be positive with a stenosis of 50 percent or more. The study found that positive screening results were obtained in 32 patients. Coronary angiography demonstrated significant lesions in 19 patients and nonsignificant lesions in seven patients. Coronary angiography was not performed in six patients. All but three of the 19 patients in whom silent coronary lesions were detected presented with type 2 diabetes. The main differences between the 16 type 2 patients who had type 2 diabetes presenting with coronary lesions and the type 2 patients without SMI were a higher prevalence of peripheral macroangiography and a higher prevalence of retinopathy. No correlation was found between SMI and duration of diabetes, glycosylated hemoglobin level, renal status, or cardiovascular risk factors except for family history of CAD. On the basis of the results, the article recommends routine screening for male patients in whom the duration of type 2 diabetes is greater than 10 years or even less when more than one cardiovascular risk factor is present. 1 figure. 3 tables. 27 references. (AA-M). •

Tests for Your Heart: When It Comes to Heart Disease, Being Forewarned Is Being Forearmed Source: Diabetes Forecast. 52(6): 56-60. June 1999. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article discusses heart tests for people who have diabetes. This disease is a major risk factor for coronary disease. Diabetes increases the risk of developing both angina pectoris and cardiac denervation syndrome. Therefore, it is important for people who have diabetes to find out the condition of their heart and vascular system. However, before any tests are conducted, a physician should obtain a thorough health history from a person who has diabetes. Various kinds of tests can be performed, including resting and stress. During resting tests, the heart is allowed to function without any extra stimulation from exercise or drugs. Such tests include a resting electrocardiogram (EKG), a chest x-ray, and a resting echocardiogram. Stress tests, however, involve stimulating the heart through exercise or with drugs so that a physician may see what happens to a person's heart rate, blood pressure, and blood flow to the heart. Stress tests include an exercise stress test with EKG, an exercise perfusion stress test, a pharmacological stress test, and a stress echocardiogram. The article describes each of these resting and stress tests and discusses the next level of testing, cardiac catheterization and angiography.

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Prevalence of Coronary Heart Disease in Subjects with Normal and Impaired Glucose Tolerance and Non-insulin-dependent Diabetes Mellitus in a Biethnic Colorado Population: The San Luis Valley Diabetes Study Source: American Journal of Epidemiology. 135(12): 1321-1330. June 15, 1992. Summary: This article reports on a study in which the prevalence of coronary heart disease was studied from 1984-1988 in 1,092 individuals with normal glucose tolerance, 173 individuals with impaired glucose tolerance, and 429 individuals with noninsulin-

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dependent diabetes mellitus. The populations ranged in age from 25 to 74 years and were from a biethnic community in the San Luis Valley, Colorado. Glucose tolerance was classified using the World Health Organization criteria, and coronary heart disease prevalence was assessed using the Rose Questionnaire and a resting electrocardiogram. Compared with normal glucose tolerance, coronary heart disease was significantly more prevalent in non-Hispanic white women and men with diabetes and in Hispanic women with diabetes, but not in Hispanic men with diabetes. Similar patterns of coronary heart disease were observed in individuals with impaired glucose tolerance. 6 tables. 40 references. (AA-M). •

Assessment of Diabetes Care by Medical Record Review: The Indian Health Service Model Source: Diabetes Care. 17(8): 918-923. August 1994. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article reports on an article to evaluate the adherence to minimum standards for diabetes care in multiple primary-care facilities using a uniform system of medical record review. Medical record reviews were conducted on 6,959 charts selected from 40,118 diabetes patients. High rates of adherence (greater than 70 percent) were noted for blood pressure and weight measurements at each visit, blood sugar determinations at each visit, annual laboratory screening tests, electrocardiogram at baseline, and adult immunizations. Lower rates of adherence (less than or equal to 50 percent) were noted for annual eye, foot, and dental examinations. The authors conclude that medical record review, using uniform definitions and inexpensive software for data entry and reports, can easily be implemented in multiple primary-care settings. 1 figure. 2 tables. 27 references. (AA-M).

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New Safety Recommendations for Use of Cisapride (Propulsid) Source: Harvard Heart Letter. 10(8): 7. April 2000. Contact: Available from Harvard Medical School Health Publications Group. Harvard Heart Letter, P.O. Box 420300, Palm Coast, FL 32142-0300. (800) 829-9045. E-mail: [email protected]. Website: www.health.harvard.edu. Summary: This brief newsletter article, from the Harvard Heart Letter, reminds readers of the new safety recommendations for the use of cisapride (Propulsid). Cisapride is used to treat severe nighttime heartburn, usually caused by gastroesophageal reflux disease (GERD), a condition where the band of muscle that prevents stomach acid from leaking back into the esophagus relaxes spontaneously, creating a painful heartburn like sensation. Cisapride works by moving gastric acids through the digestive tract, thereby preventing their painful reflux into the esophagus. Because this drug has some risks, it is generally reserved for patients who have not responded well to lifestyle changes or other medications used to manage GERD. Serious adverse reactions occurring in patients on cisapride have included heart rhythm disorders and death (most often occurring in people with certain health problems or who were taking other medications). Although it could not find a direct link between the reported problems and cisapride, the U.S. Food and Drug Administration (FDA) did strengthen the precautions on using this drug. In January 2000, the FDA bolstered its efforts to reduce the likelihood of complications from cisapride by recommending that physicians consider performing an electrocardiogram and certain blood tests before prescribing it.

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The article lists the drugs that should not be combined with cisapride, as well as the complicating medical conditions that contraindicate its use. •

Go See a Nephrologist Source: in Shtasel, P. Medical Tests and Diagnostic Procedures: A Patients Guide to Just What the Doctor Ordered. New York, NY: Harper and Row Publishers. 1990. p. 66-69. Contact: Available from Harper and Row Publishers. 10 East 53rd Street, New York, NY 10022. (212) 207-7000, (800) 242-7737 or (800) 982 4377. Summary: This chapter describes diagnostic procedures employed by a nephrologist regarding evaluation of kidney disease. It covers physical examination, laboratory testing, electrocardiogram, nuclear imaging, ultrasound, x-rays, and biopsy. For each procedure it provides information about discomfort, hazard, hospitalization, informed consent requirement, and special preparation, and exam time.

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Noninvasive Assessment of the Diabetic Patient for Coronary Artery Disease Source: Diabetes Care. 24(9): 1519-1521. September 2001. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This editorial discusses noninvasive assessment of the diabetic patient for coronary artery disease. People who have diabetes have a much greater risk of developing cardiovascular disease than people who do not have diabetes. A broad range of clinical trials have demonstrated the benefits of lipid lowering therapy on cardiovascular event rates. Also important is the aggressive control of hypertension. However, the cardiovascular benefits of traditional therapy for hyperglycemia (insulin or insulin secretagogues) has not been convincingly demonstrated. Simultaneous with advances in the treatment of diabetes, particularly regarding cardiovascular risk, there has been a growth in the available options for diagnosing and treating coronary artery disease (CAD). Although mortality from CAD has declined in the past two decades, these declines have not been enjoyed to the same degree by people who have diabetes. Thus, the development of accurate and cost effective diagnostic tests is important. Options available to evaluate patients noninvasively for CAD have increased over the years. Exercise tolerance testing using conventional electrocardiogram monitoring was once the only available method. Problems with this method led to the development of adjunctive myocardial imaging such as stress nuclear (SN) testing and stress echocardiography (SE). The editorial highlights research on these techniques and concludes that the best noninvasive test for people who have diabetes and are being evaluated for CAD remains unclear. 31 references.

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15-Year Longitudinal Study of Blood Pressure and Dementia Source: Lancet. 347: 1141-1145. April 27, 1996. Summary: This journal article describes a 15-year study of the association between blood pressure and the development of dementia in older people. Residents of Goteborg, Sweden, who were 70 years in 1970-1972 participated in this study. A random subsample of 382 residents who did not have dementia on psychiatric evaluation at age 70 years were followed for 15 years with repeated neuropsychiatric examination and physical examination, electrocardiogram, chest radiograph, and blood tests. The results suggest that participants who developed dementia at age 79-85 years had significantly higher systolic blood pressure at age 70 years and significantly higher diastolic blood

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pressure at ages 70 and 75 years than did those who did not develop dementia. A significant association was found between higher diastolic blood pressure at age 70 years and subsequent development of Alzheimer's disease, and between higher diastolic blood pressure at age 75 years and subsequent development of vascular dementia. Participants with white matter lesions on computed tomography at age 85 years had higher blood pressure at age 70 than those without such lesions. In participants who developed dementia, blood pressure declined just before dementia onset and was then similar to or lower than that in participants without dementia. The authors conclude that increased blood pressure at age 70 years may increase the risk of developing dementia 10 to 15 years later. 4 figures, 1 table, 30 references. •

Safety/Tolerability Trial of SDZ ENA 713 in Patients With Probable Alzheimer's Disease Source: Life Sciences. 58(15): 1201-1207. 1996. Summary: This journal article describes a study of the safety and efficacy of SDZ ENA 713 (ENA 713), an acetylcholinesterase inhibitor, in the treatment of people with probable Alzheimer's disease (AD). Fifty outpatients with probable AD, mean age 68 years, were randomly assigned to receive ENA 713 bid (n=20), ENA tid (n=20), or placebo (n=10) for 9 weeks in a fixed escalation schedule, followed by a 1-week washout period. The escalation schedule was identical for the two ENA 713 groups, starting at 2 mg/day in weeks 1 and 2, and increasing to 12 mg/day in weeks 8 and 9. Safety assessments included physical examination, vital signs, electrocardiogram, clinical laboratory evaluations, and volunteered and observed adverse event reports at regular intervals. In addition, patients and caregivers maintained a diary of adverse effects. The results suggest that ENA 713 in doses up to 12 mg/day were well tolerated. Most adverse events were mild to moderate in severity and of limited duration. Three of the 40 patients who received ENA 713 discontinued the treatment due to adverse events: 2 had nausea and vomiting, and the third had an unrelated mild atrial fibrillation. 1 table, 22 references.

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Overdiagnosis of Dementia Source: Journal of the American Geriatrics Society. 29(9): 407-410. September 1981. Summary: This journal article reports the results of a study of the rate of diagnostic error for 100 patients referred to a specialized outpatient dementia clinic. Of these patients, at least 26 were not demented, 15 had depression, 7 had miscellaneous other neuropsychiatric disorders, and 4 were normal. Specialized dementia clinics help to improve diagnostic accuracy. The results indicated that three diagnostic errors appeared to be particularly significant: (1) the failure to recognize depression, especially in the presence of mild organic brain disease; (2) equating brain atrophy on the computerized tomogram with clinical dementia; and (3) the failure to distinguish focal from global intellectual impairment. It is concluded that the complete evaluation of patients who may have dementia requires at least a detailed neurologic history and physical examination; a psychiatric evaluation with particular attention to depression; a general medical evaluation with care to detect subtle metabolic, toxic, or cardiopulmonary disorders which can precipitate confusion; a series of neuropsychologic tests to document the type and severity of cognitive impairment; an evaluation by a social worker who can mobilize suitable community resources; and appropriate laboratory studies, including an electrocardiogram and a computed tomography scan. 18 references.

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Electrocardiogram

Hyperglycemic Crises in Patients with Diabetes Mellitus Source: Clinical Diabetes. 19(2): 82-90. May 2001. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This position statement outlines precipitating factors and recommendations for the diagnosis, treatment, and prevention of diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). The basic underlying mechanism for both DKA and HHS is a reduction in the net effective action of circulating insulin coupled with a concomitant elevation of counterregulatory hormones. Infection is the most common precipitating factor in the development of both disorders. Other factors include cerebrovascular accident, alcohol abuse, pancreatitis, myocardial infarction, trauma, and drugs that affect carbohydrate metabolism. Although the process of HHS usually evolves over several days to weeks, the evolution of the acute DKA episode in type 1 or type 2 diabetes tends to be much shorter. For both DKA and HHS, classical clinical features include a history of polyuria, polydipsia, polyphagia, weight loss, vomiting, abdominal pain, dehydration, weakness, clouding of sensorium, and finally coma. The initial laboratory investigation of patients with suspected DKA or HHS should include determination of plasma glucose, blood urea nitrogen/creatinine, serum ketones, electrolytes, osmolality, urinalysis, urine ketones by dipstick, initial arterial blood gases, complete blood count with differential, and electrocardiogram. Treatment of DKA and HHS requires correction of dehydration, hyperglycemia, and electrolyte imbalances; identification of comorbid precipitating events; and frequent patient monitoring. The article provides guidelines on administering fluid and insulin therapy to adult and pediatric patients, identifies the most common complications of DKA and HHS, and presents ways to prevent DKA and HHS. 4 figures. 3 tables. 39 references.

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

2

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

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Project Title: AUTONOMIC CONSEQUENCES OF BRIEF SEIZURES Principal Investigator & Institution: Stewart, Mark G.; Associate Professor; Physiology and Pharmacology; Suny Downstate Medical Center 450 Clarkson Ave New York, Ny 11203 Timing: Fiscal Year 2003; Project Start 01-MAR-2003; Project End 28-FEB-2005 Summary: (provided by applicant): Focal and generalized seizures can influence autonomic nervous system (ANS) function. Flushing, sweating and piloerection are reported in some patients with simple partial seizures. A broader spectrum of autonomic signs, including changes in heart rate and rhythm (most often bradycardia), blood pressure (most often pressure increases), pupillary size, vasomotor and sudomotor activity, GI motility and secretion, is reported in patients with complex partial seizures. Generalized tonic-clonic seizures can be associated with severe increases in blood pressure and changes in heart rate (e.g. complete nodal block). In spite of an apparent pattern of increasing autonomic dysfunction with increasing seizure intensity, sudden death during a seizure is not limited to cases of status epilepticus or even generalized tonic-clonic seizures. It is possible that some seizures, particularly those that result in sudden death, cause dangerous autonomic over-activity. The extent of seizure-induced alterations in autonomic nervous system function, acutely and chronically, has not been well studied. It is not clear whether autonomic changes are entirely secondary to motor manifestations or if autonomic consequences are independent have motor activity, perhaps even being significant in a non-convulsive seizure. The short term goals of this pilot study are to determine experimentally the feasibilty of measuring peripheral parameters related to ANS function before, during and after seizures of different onset (focal vs. generalized) and duration; and to correlate changes with the types of seizures. We have developed a custom chronic recording system for long-term monitoring of blood pressure (BP), electrocardiogram (ECG), and peripheral nerve activity (sympathetic postganglionic axons) in freely-behaving rats to assess changes mediated by the autonomic nervous system. We will determine the feasibility of adapting our system to monitor autonomic parameters during 5 seizure conditions: a) focal seizures; b) focal seizures with secondary generalization; c) primarily generalized seizures; d) status epilepticus; and e) spontaneous seizures in a chronic seizure model. Specifically, we will compare focal with generalized seizures, and primarily generalized with secondarily generalized seizures. In animals that develop spontaneous seizures, we will compare triggered with spontaneous seizures. We will also correlate the duration of electroencephalographic seizure activity with the intensity of motor convulsions. Focal and secondarily generalized seizures will be studied in perirhinal kindled rats. Primarily generalized seizures will be studied in rats exposed to flurothyl gas. Status epileptics and spontaneous seizures will be studied in rats injected with kainic acid. Lastly, we will define whether any changes in autonomic parameters can predict the occurrence of sudden death in the fraction of animals that die during flurothyl-induced seizures. Defining seizure-induced autonomic changes will permit development of specific therapies to reduce or prevent some of the serious acute consequences of seizures, such as sudden death, and will improve understanding of the long-term consequences of repeated seizures. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: GAMBLING

BUPROPION

VS

PLACEBO

TO

TREAT

PATHOLOGICAL

Principal Investigator & Institution: Black, Donald W.; Professor; Psychiatry; University of Iowa Iowa City, Ia 52242

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Electrocardiogram

Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 31-MAY-2005 Summary: (provided by applicant): Pathological gambling (PG) has become a major health concern, particularly as gambling opportunities have proliferated. Despite its importance, there are few treatment options with proven efficacy. This application is submitted in response to PAR-99- 134 "Exploratory/Development Grants for MH Intervention/Research" The goal of the project is to conduct a randomized, double-blind comparison of bupropion-SR versus placebo in the treatment of PG. Bupropion will be used because of its reported efficacy in treating attention-deficit hyperactivity disorder (ADHD), and clinical similarities between PG and ADHD. This study will be one of the first of its kind, and has the potential to provide pilot data supporting the efficacy of a novel treatment for PG. We propose to recruit approximately 80 adults with DSM-IV PC during the first two years of the project, and to randomize subjects to bupropion-SR or placebo for a 12-week clinical trial. Subjects will be recruited through physician referral, advertisements in the local media, and by word-of-mouth. Subjects will be screened with the 20-item South Oaks Gambling Screen (SOGS) and the NORC DSM Screen for Gambling Problems (NODS). Those screening positive for PG (SOGS score equal to or >5 and NODS score equal to or >5) will be offered inclusion in the trial provided they meet specified inclusion/exclusion criteria. Baseline assessments will include the Structured Clinical Interview for DSM-IV, the Structured Interview for DSM-IV Personality Disorders, the Yale-Brown Obsessive-Compulsive Scale Modified for PG (YBOCS-PG), the Hollingshead Scale, the NORC Gambling Self-Administered Questionnaire, and the Global Assessment Scale. Baseline assessment will also include a physical examination, an electrocardiogram, urine drug screen, and other screening laboratories. Measures to gauge improvement will include the YBOCS-PG, three Clinical Global Impression scale ratings, a patient self-rated scale, the Hamilton Depression Rating Scale, and the Attention Deficit Hyperactivity Disorder (ADHD) Symptom Checklist. Following a two-week screening period, subjects will be randomized to medication or placebo. The dosage of bupropion-SR will begin at 100 mg twice daily and increased weekly to a total of 400 mg daily. Subjects on placebo will be administered a similar number o tablets. Subjects will be seen at weeks 1, 2, 4, 6, 8, 10, and 12. Adverse events and concomitant medications will be recorded at each visit. We hypothesize that the subjects receiving bupropion will have better symptomatic improvement than subjects receiving placebo. Further, we hypothesize that symptoms consistent with attention-deficit disorder will improve in parallel to the reduction in PG behavior. If bupropion is confirmed as an effective treatment, future studies will include larger samples to help test whether specific subgroups will improve preferentially, and comparisons of bupropion with the SSRI fluvoxamine, and naltrexone, an opiate antagonist, both shown to have efficacy in treating PG. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CARDIAC CONNEXINS IN IMPULSE PROPAGATION AND ARRHYTHMIAS Principal Investigator & Institution: Jalife, Jose; Professor of Pharmacology; Upstate Medical University Research Administration Syracuse, Ny 13210 Timing: Fiscal Year 2002 Summary: Intercellular communication is essential for normal cardiac impulse propagation. It is thought to be mediated by gap junction channels. Three gap junction proteins, known as connexins (Cxs), are expressed in the heart; these are Cx40, Cx43 and Cx45. However, the specific role of the individual connexins in normal and abnormal propagation is unknown. The recent development of connexin knockout mice now

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makes such knowledge possible. Our overall objective is to investigate the electrophysiological consequences of the absence of specific gap junction channels on impulse propagation in mice lacking either Cx43 or Cx40. We will combine electrocardiographic, microelectrode and patch- clamping techniques, with highresolution microscopic and macroscopic optical recordings of potentiometric dye fluorescence, to measure relevant electrophysiological parameters, which may be affected by Cx43 and Cx40 null mutation. Our Specific Aims are 1. To determine the electrophysiological consequences and pro-arrhythmic effects of reduced intercellular coupling in the ventricles of neonatal homozygote and heterozygote Cx43 knockout mice. We hypothesize that the lack of Cx43 results in a reduction of intercellular communication leading to discontinuous conduction, with an increase in the variability of local conduction times during both sinus rhythm and pacing. Moreover, we surmise that impulse blockade in the homozygote mice will occur preferentially in the direction transverse to fiber orientation and at much slower frequencies than in wildtype or heterozygous mice. 2. To determine the role of Cx40 in impulse propagation in the specialized conducting system, and ventricles of the adult mouse heart. Our hypothesis here is that the null mutation of Cx40 decreases intercellular communication in the specialized conduction system and slows Purkinje fiber conduction velocity, leading to an apparent bundle branch block configuration in the electrocardiogram, and facilitating the induction of reentrant arrhythmias. Further, because of source-sink relationships, we expect that conduction block is more likely to occur at branch points and the Purkinje-muscle than along the Purkinje bundles. 3. To determine the effects of Cx40 null mutation on sinus rhythm and impulse propagation in the atria of the adult mouse heart. Cx40 is expressed in both atria and the sinus node of the mouse. It has been shown that the lack of Cx40 results in P wave prolongation and atrial tachyarrhythmias, including fibrillation. However, in the absence of such arrhythmias, RR interval is unaffected in Cx40-/- mice. We postulate that Cx40 plays a crucial role in intercellular communication in the atria and helps maintain normal intraatrial conduction, but is not essential for synchronized pacemaker discharge in the sinus node. We propose also that the reduction in intercellular communication within the atria of the CX40 knockout mouse is accompanied by an increased susceptibility to reentrant arrhythmias. Overall, the studies proposed are highly significant in that they will provide definite proof or refutation to long-held assumptions regarding the fundamental role of connexins in cardiac electrophysiology and arrhythmias. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CARDIAC DISEASE IN COOLEYS ANEMIA--MOLE AND CLIN STUDIES Principal Investigator & Institution: Brittenham, Gary M.; Professor of Medicine; Anatomy and Cell Biology; Columbia University Health Sciences New York, Ny 10032 Timing: Fiscal Year 2002; Project Start 30-SEP-1998; Project End 31-JUL-2004 Summary: The proposed research project is designed to characterize the molecular pathophysiology and clinical consequences of iron-induced cardiac disease using a coordinated series of studies of cardiac myocytes in culture, of the first animal model of the cardiomyopathy of iron overload, and of patients with thalassemia major. Ironinduced myocardial disease is the most frequent cause of death in thalassemia major and is a major life-limiting complication of other transfusion- dependent refractory anemias hereditary hemochromatosis and other forms of iron overload. We hypothesize that (i) the body iron burden is a principal determinant of the magnitude of cardiac iron deposition in patients with thalassemia major, (ii) the nonuniform pattern of iron

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Electrocardiogram

deposition in the heart results in variability in iron concentrations within cardiac myocytes, and (iii) the increased intracellular iron selectively affects specific ion channels in cardiac myocytes, producing abnormalities in sodium and potassium currents that result in aberrant ventricular repolarization and contribute to arrhythmogenesis. The proposed research has three specific aims: (1) to determine the pathophysiologic mechanisms responsible for iron-induced abnormalities of Na+ and K+ currents in cultured neonatal rat cardiac myocytes and the effects of iron chelators, antiarrhythmic drugs and other agents; (2) to examine the effects of excess iron, iron chelators, antiarrhythmic drugs and other agents on cardiac electrophysiology and function in a gerbil model of iron overload both in the intact animal and in isolated heart preparations; and (3) to determine the relationship in patients with thalassemia major between body iron burden, as measured by non- invasive magnetic susceptometry, and abnormalities of cardiac rhythm and function, as assessed as assessed by the signalaveraged electrocardiogram, T wave alternans, dynamic measures of the QT interval and echocardiography. This research will result in new fundamental information about the molecular basis for the effects of iron on cardiac ion channels, will provide the first electrophysiolgical and functional studies in a new animal model of iron overload, and will develop new non-invasive means of identifying those patients at the highest risk for iron-induced cardiac disease to permit intensive iron chelation therapy and other preventive interventions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DEVELOPMENT OF ECG SOFTWARE TO DETECT AMI Principal Investigator & Institution: Warner, Robert A.; Inovise Medical, Inc. 1025 Industrial Pky, Ste C Newberg, or 97132 Timing: Fiscal Year 2003; Project Start 01-JUL-1999; Project End 31-MAY-2005 Summary: (provided by applicant): Our goal is to develop a computerized algorithm for the electrocardiogram (ECG) that will facilitate the reliable and early detection of acute myocardial infarction (AMI). The widely recognized value of thrombolytic therapy when delivered early in the management of patients with acute MI has made the development of such an algorithm especially important. Current algorithms for ECG interpretation do not provide the levels of sensitivity and specificity that are desirable. Our phase 1 findings demonstrate the feasibility of significant improvements in accuracy of identification of acute MI that may be achieved by taking into account age and gender and by factoring in such confounders as coexisting LVH, ST changes due to conditions other than acute myocardial infarction, and influences of prior infarcts. In phase 2, we plan to further improve corrections based on age and gender using a larger and more diverse database of ECGs. We will expand our database to include a much larger number of African American individuals and develop algorithms to account for differences between this population and Caucasians. We propose also to strengthen our algorithms that correct for several confounding factors. The databases we will use have associated non-ECG clinical information that provide confirmation of acute MI that will be used as the "gold standard" for assessing accuracy. Validation will also include comparisons of accuracy achieved by our developed system compared to the most recent commercially available ECG interpretive systems. The demonstration of significant diagnostic improvement will lead to considerable commercial opportunities based upon the high prevalence and incidence of acute myocardial infarction. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: DIASTOLIC DYSFUNCTION & ATRIAL FIBRILLATION IN ELDERLY Principal Investigator & Institution: Tsang, Teresa S.; Mayo Clinic Rochester 200 1St St Sw Rochester, Mn 55905 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-AUG-2008 Summary: (provided by applicant): Nonvalvular atrial fibrillation (AF) is an age-related public health problem associated with marked morbidity and mortality. We propose to prospectively examine the structural, hemodynamic, and neurohormonal/ inflammatory factors associated with first AF and investigate whether sleep apnea independently predicts AF. In Aim 1, we will confirm that diastolic function and left atrial (LA) volume are predictive of AF, incremental to clinical and other echocardiographic variables. We hypothesize that diastolic dysfunction and increased LA volume independently predict nonvalvular AF. In Aim 2, the distribution and correlates of changes in diastolic function and LA volume will be described, and we will determine whether serial measurements of these parameters provide incremental information on risk of AF. In Aim 3, we plan to explore how neurohormonal activation, specifically atrial natriuretic peptide (ANP) release, and the inflammatory marker, Creactive protein (CRP), are associated with LA size, diastolic function, and AF development. We hypothesize that there is an independent role for ANP, but not for CRP, in the prediction of AF, after clinical and echocardiographic parameters have been considered. In Aim 4, we will assess relationships between arterial stiffness, diastolic function and LA volume, and determine whether arterial stiffness independently predicts AF. In Aim 5, we will evaluate sleep apnea as an independent predictor of AF development, after accounting for other clinical and echocardiographic risk factors. We plan to recruit 800 adults at significant risk for nonvalvular AF on the basis of age > 65 years and the presence of two or more known AF risk factors (hypertension, diabetes, history of coronary artery disease, and history of congestive heart failure). Prior history of AF, embolic stroke, organic valvular disease and congenital heart disease are the major exclusion criteria. All participants must be able to provide informed consent. Echocardiography, electrocardiogram (ECG), ANP, CRP, noninvasive arterial stiffness assessments (pulse wave velocity and augmentation index) will be obtained at baseline and annually thereafter. The Berlin Sleep Questionnaire to assess risk of sleep apnea will be completed by all participants at baseline and annually. A subgroup of 200 participants will undergo sleep studies, using a portable recording system, for detection of sleep apnea. Ascertainment of AF involves regular ECG surveillance, and patient report of AF with ECG confirmation. Identification of the cascade of factors contributing to AF development will have important implications in primary prevention of this major public health problem. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ECG EDUCATIONAL SOFTWARE FOR HEALTH PROFESSIONALS Principal Investigator & Institution: Goldsworthy, Richard; Director, R&d; Academic Edge, Inc. 216 W Allen St, Ste 143 Bloomington, in 47403 Timing: Fiscal Year 2002; Project Start 01-FEB-2002; Project End 30-OCT-2002 Summary: Electrocardiogram is the most common cardiac examination ordered by physicians. In the past, only persons working in the ECG laboratory were allowed to perform a 12-lead ECG on a patient. Today, however, this task has been delegated to a variety of health professionals, including registered nurses, licensed practical nurses, and even nursing assistants in some health care facilities. There is a need for educational

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Electrocardiogram

programs that meet the needs of these practitioners while minimizing resource expenditure. This project proposes the design, development, and evaluation of simECG, a multimedia, simulation-based system to train health care professionals in the use and troubleshooting of ECG machines. Phase I will implement the underlying simulation, an introductory section on the physiological processes underlying ECGs, a single simulated case patient for training the user in performing an ECG, and a parallel assessment module. The design and development will be evaluated through three efforts: (1) a subject-matter-expert review, to include quality assurance by a cardiologist, and (2) an end-user focus group review of the product at three stages--initial design, alpha prototype, and beta prototype. The prototype will also be evaluated in (3) a controlled field trial of 100 randomly assigned target users. PROPOSED COMMERCIAL APPLICATION: Targeted commercial applications include sale of the product to universities, hospitals, and other health professional training organizations. The product may also be marketed directly to practitioners for continuing education. Given the rapid growth of the health care training industry as well as the expansion of ECG use to members outside the ECG laboratory, the market for such a training system is quite large. The underlying simulation will lead to work in simulating other medical devices for training thereby opening further markets. Finally, ECG manufacturers will be contacted for phase 3 partnerships for machine-specific support packages. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EPIDEMIOLOGY OF CARDIOVASCULAR DISEASE IN DIABETES Principal Investigator & Institution: Bowden, Donald W.; Professor; Biochemistry; Wake Forest University Health Sciences Winston-Salem, Nc 27157 Timing: Fiscal Year 2002; Project Start 15-JUL-2001; Project End 30-JUN-2005 Summary: The goal of this study is to locate and identify genes contributing to the genetic component of subclinical cardiovascular disease (CVD) in Type 2 diabetes and to evaluate the impact of lifestyle and environment on the expression of these genetic components of subclinical CVD. These goals will be achieved by the concerted efforts of clinicians, epidemiologists, and geneticists. The hypotheses are: 1) The risk of developing Type 2 diabetes-associated cardiovascular disease (CVD) has a significant heritable component that can be measured, and 2) The chromosomal locations of genes contributing to CVD in Type 2 diabetes can be determined and the genes identified using modern molecular genetic approaches. The investigators predict that these genetic factors can be detected in studies of sibling pairs with Type 2 diabetes through genetic epidemiology methods and linkage analysis. Type 2 diabetes-affected sibling pairs, unaffected siblings, and parents, if available, will be recruited and multiple clinical and subclinical measures of subclinical CVD risk will be assessed, including coronary artery calcification (CAC), carotid arterial wall thickness (IMT), ECG variables, and prevalent CVD. Data on the patients is collected in one visit to the General Clinical Research Center (GCRC) which includes an interview and physical examination, a resting 12-lead electrocardiogram (ECG), B-mode ultrasound of the carotid arteries, retrospectively gated helical CT (RGHCT), and a spectrum of clinical laboratory measures. Genetic and epidemiological methods will be used to evaluate the familial aggregation of subclinical CVD taking into consideration the effects of shared environmental exposures (e.g. smoking, diet, alcohol intake and physical activity) and clinical measures (e.g., BMI, blood pressure, lipids, age, sex, etc.). Initial estimates of heritability suggest a significant heritable component to subclinical CVD. Clinical evaluation will be followed by a comprehensive molecular genetic analysis of the sib pairs/families including a genome wide screen, which will be followed by a focused effort to create a high quality dataset

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by regenotyping or replacing problem markers. Evidence for linkage to QTLs influencing CAC and IMT will be pursued in those chromosomal regions showing suggestive evidence for linkage and then performing further analyses to detect associations with these "saturation" markers. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HIGH FRAME RATE WITH LIMITED DIFFRACTION BEAMS Principal Investigator & Institution: Lu, Jian-Yu X.; Professor; Bioengineering; University of Toledo 2801 W Bancroft St Toledo, Oh 43606 Timing: Fiscal Year 2001; Project Start 11-SEP-1997; Project End 30-APR-2004 Summary: The long term goal of the proposed project is to produce unique high frame rate two-dimensional (2D) and ultimately three-dimensional (3D) images of human heart and cardiovascular systems to improve diagnostic potentials. The current research is designed to 1) study a newly discovered image construction method for both high frame rate 2D and 3D imaging using computer simulations, 2) construct a prototype imaging system capable of high frame rate 2D B-mode imaging (approximately 3750 frames/s for a depth of 200 mm), and 3) evaluate the method in vitro and in vivo using the prototype system. The current goal will be achieved through the following specific aims: Specific Aim 1: Study of Fourier Construction Method. We will study the theory of the new Fourier image construction method for ultra high frame rate 2D and 3D imaging. Influence of nonuniform frequency-dependent attenuation and phase aberration on the images will be studied with computer simulations. Implementation of the method with simplified hardware will be investigated. Study of limited diffraction beams will continue. Specific Aim 2: Development of a Prototype 2D Imaging System. A prototype 2D high frame rate imaging system will be constructed. This includes the development of a multichannel array transducer, transmitter, and receiver. The system will also have the capabilities of beam steering, on-line image construction, and electrocardiogram (ECG) controlled data acquisition. Specific Aim 3:In vitro Evaluation of the New Imaging Method. The Fourier construction method will be evaluated with the prototype system in vitro, on tissue-equivalent phantoms, tissue samples, and flow phantoms. Specific Aim 4: Preliminary In Vivo Studies. The Fourier constructionmethod will also be studied in vivo with the prototype system. A limited number of volunteers and patients will be studied. Both high frame rate 2D tissue and flow images will be constructed and evaluated by physicians for their diagnostic potentials. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: HORMONE REPLACEMENT THERAPY WITH PROGESTERONE CREAM Principal Investigator & Institution: Hermsmeyer, Kent R.; Dimera, Llc. 2525 Nw Lovejoy St, Ste 401 Portland, or 97210 Timing: Fiscal Year 2000; Project Start 13-AUG-1998; Project End 31-AUG-2004 Summary: The objective of this project is to further develop a new progesterone formulation that is effective for hormone replacement therapy-protecting the coronary arteries against hyperreactivity. Such hyperreactivity results from the deficiency of progesterone after the cessation of ovarian function after menopause during the normal aging process. The anticipated new product will be further studied in monkeys in the catheterization laboratory and in human stress test electrocardiogram and echo cardiology protocols. These studies will determine the effectiveness of progesterone in extending treadmill stress test duration, echocardiographic cardiac wall motion, and

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lipid biochemical measures of coronary function. We will also explore the possible relationship of changes in blood lipids and platelet function. The new formulation is designed to be accepted sufficiently well by post- menopausal women to encourage compliance among those who initiate hormone replacement therapy-for a duration of decades in many cases. Protection of the cardiovascular system by progesterone can be expected to provide for a significant decrease in the incidence of cardiovascular disease during aging, and improved quality of life in post-menopausal women. The skin cream formulation is well accepted by women, has optimal pharmacokinetics for a once a day treatment, and is hypothesized to reduce cardiovascular risks, including coronary artery disease. Even though the risk of death due to cardiovascular causes is nearly 50% for post-menopausal women, and is far greater than any other risk, the presently available forms of hormone replacement therapy are used by only a fraction of those who would benefit. This leading risk of death and' available measures to minimize that risk are neither well understood nor readily accepted by post-menopausal women. This formulation has the potential to significantly improve that situation and enhance quality of life in post-menopausal women. PROPOSED COMMERCIAL APPLICATIONS: The percutaneous formulation of progesterone will produce a blood level to minimize the risk of cardiovascular disease, and thus may find widespread application in hormone replacement therapy. The number of people who would be potential consumers for the product consists of all postmenopausal women, a rapidly growing number which already exceeds 20 million. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FIBRILLATION

MECHANISM

FOR

PRESSURE

COLLAPSE

WITHOUT

Principal Investigator & Institution: Malkin, Robert A.; Biomedical Engineering; University of Memphis Memphis, Tn 38152 Timing: Fiscal Year 2002; Project Start 01-MAR-2000; Project End 28-FEB-2004 Summary: The American safety standard for 60 Hz leakage current through the heart was recently increased from 10 muA to 50 muA based on the estimated ability of AC current to induce ventricular fibrillation (VF). VF causes systemic blood pressure collapse, then death. However, we recently showed that pressure collapse can result from leakage currents (84 +/- 27 muA rms) far below those required to induce VF (278 +/- muA in 32 closed-chest humans). The goal of this project is to determine the mechanism by which prolonged, unipolar, microampere, AC stimuli can cause systemic blood pressure collapse without inducing VF. We propose the following hypotheses: (1) Sinusoidal, 60 Hz, unipolar current stimulation lasting three seconds or longer through the in situ heart at rms amplitudes below the VF threshold can consistently elicit a propagated electrical and mechanical response following the same three cellular mechanisms as seen in nerves. (2) As the AC stimulus strength increases the elicited heart rate increases (not rate/rate like pacing) at currents above the stimulation threshold and below the VF threshold, and (3) Once the AC-elicited rate exceeds some threshold, the blood press collapses because the heart becomes isovolumic, developing contractile force either (3.1) synchronously, but without geometric change, or (3.2) asynchronously, leading to ineffective geometry changes. We will show a consistent response in dogs by recording the activation rate of (1A) the elicited electrical response using a new type of notch-filtering electrocardiogram which removes the AC stimulus artifact, and the rate of the mechanical response using (1C) one-dimensional ultrasound and (1B) an epicardial strain gage. The elicited rate for stimulus frequencies from 10160Hz and ms currents from 10 muA to the VF threshold will be used to determine the

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relative importance of three cellular-level stimulation mechanisms at 60 Hz. We will (2A) measure the elicited rate as a function of stimulus strength, showing a strength/rate relationship. We will confirm the existence of a rate threshold by showing (3A) that pacing causes pressure collapse at the same rate as AC stimulation. We will demonstrate an isovolumic heart by measuring the volume using (3B) ultrasonic and (3C) impedance techniques. We will (3D) mount multiple strain gages and electrodes on the epicardium, measuring the mechanical and electrical rate and phase to calculate the degree of (3.1) synchrony or (3.2 asynchrony). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MYOCARDIAL PROTECTION BY NHE-1 INHIBITION Principal Investigator & Institution: Gazmuri, Raul; Medicine; Finch Univ of Hlth Sci/Chicago Med Sch North Chicago, Il 60064 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-JUL-2006 Summary: (provided by applicant): The current proposal is for studies on the mechanisms of myocardial protection associated with inhibition of the sarcolemmal Na+-H+ exchanger isoform-1 (NHE-1). Studies are conducted in a porcine model of whole-body ischemia induced by ventricular fibrillation (VF) in which resuscitation is either attempted using conventional closed-chest resuscitation or simulated using peripheral cardiopulmonary bypass, according to four specific aims designed to study 1) the mechanisms by which NHE-1 inhibition ameliorates ischemic contracture during resuscitation from VF, 2) the mechanisms by which post-resuscitation ventricular ectopic activity is reduced after NHE-1inhibition, 3) the late post-resuscitation effects of NHE-1 inhibition on cardiovascular and neurological function, and 4) the effects of NHE-1 inhibition when instituted before the onset of VF on subsequent resuscitation and survival. The mechanisms of ischemic contracture are investigated by measuring myocardial blood flow (fluorescent microspheres) and oxidative injury (isoprostane levels) in a closed-chest resuscitation model and by measuring myocardial Na+ and high-energy nucleotides under conditions of controlled coronary blood flow using cardiopulmonary bypass. The mechanisms of post-resuscitation ectopic activity are investigated by recording monophasic action potentials in relation to NHE-1 inhibition, Na+-Ca2+ exchanger inhibition, and sarcolemmal K+ATP channel blockade. The late post-resuscitation outcome is assess by using implantable sensors measuring blood pressure, the electrocardiogram, temperature, and mobility over a period of 7 days postresuscitation. Finally, the effects of pretreatment with NHE-1 inhibition are compared with those when treatment is started during the resuscitation effort. Interventions that can increase outcome after onset of VF (even by a small fraction) could have a dramatic public health effect by saving thousands of lives. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: INFARCTION

NEW

ECG

CRITERIA

FOR

POSTERIOR

MYOCARDIAL

Principal Investigator & Institution: Wung, Shu-Fen; None; University of Arizona P O Box 3308 Tucson, Az 857223308 Timing: Fiscal Year 2002; Project Start 30-SEP-2001; Project End 30-JUN-2005 Summary: (provided by applicant): The long-term objective of this proposal is to establish a more sensitive and specific electrocardiogram (ECG) criteria that can be used for early and accurate detection of an acute posterior myocardial infarction (MI). These new ECG criteria can be used by nurses and other clinicians to facilitate decision-

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making in the Emergency Department (ED) and expand the use of revascularization therapies to patients suspected of having an acute posterior MI. Currently, standard 12lead ECGs are obtained on all patients presenting to the ED with chest pain. The 12-lead ECG has been useful in the diagnosis of acute anterior and inferior MI's, however standard 12-leads are not in the optimal anatomic position for the detection of posterior ischemia. Therefore, the specific aims of this proposal are: 1) to determine in subjects (n=1083) presenting to the ED for rule out of MI, if the use of a 15-lead ECG (standard 12-lead + posterior leads V7-9) and 0.5 mm ST segment elevation in two contiguous posterior ECG leads is more discriminating in correctly classifying patients (n=40) as having an acute posterior MI; 2) to determine if continuous 15-lead ECG monitoring (12 hours) vs. serial 15-lead ECGs improves the diagnostic precision, 3) to determine the presenting symptoms in acute posterior MI patients and, 4) to determine during a 6month follow-up, the prevalence of associated complications in patients with posterior MI. Serial and continuous 15-lead ECGs, along with echocardiography, CK-MB mass and troponin I levels will be obtained in male and female patients (n=1083) presenting to the ED for rule out of MI. The sensitivity, specificity, and predictive accuracy of the above ECG criteria for detecting acute posterior MI will be determined and validated against echocardiographic data and changes in serum cardiac markers of MI. Using Myocardial Infarction Symptoms Profile questionnaire, subjects with posterior MI will be interviewed to determine clinical profiles of symptom presentation. The incidence of in-hospital and six-month complications, such as papillary muscle dysfunction and mitral regurgitation, will be determined. This study will aid in the detection and followup of patients with posterior myocardial infarction. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NEW STATISTICAL METHODS FOR MEDICAL SIGNALS AND IMAGES Principal Investigator & Institution: Johnstone, Iain M.; Professor; Statistics; Stanford University Stanford, Ca 94305 Timing: Fiscal Year 2002; Project Start 10-SEP-1996; Project End 30-JUN-2003 Summary: Medical and biological data often come in the form of digitized signals and images; for example, magnetic resonance images, electrocardiogram traces and even the folding paths of proteins. As instrumental data acquisition becomes routine, sequences of such images, signals or paths are collected, often along with other covariate measurements, resulting in datasets where the basic unit of measurement, or response, is a high-dimensional object. The project continues to focus on developing techniques for modelling and understanding such data that explicitly take into account, and indeed exploit inherent spatial or temporal correlation, and when appropriate, relate it to covariate or class label information. To study covariance structure, the project proposes "sparse" forms of principal components and discriminant analysis that may be more sensitive to either local phenomena of not necessarily smooth form or that are more adapted to irregularly observed data. Corresponding quadratically regularized methods in appropriate bases form a natural foil for comparison, and will also be developed in certain applications. For estimation of means, the project will examine sparse empirical Bayes methods for estimating non smooth local phenomena. Much of this work will be carried out in existing and new collaborations with researchers in medical imaging, cardiology and other specialties, working for example on cancer, heart disease and brain mapping. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: NONINVASIVE & GENETIC DIAGNOSIS OF LONG QT SEGMENT Principal Investigator & Institution: Kaufman, Elizabeth S.; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106 Timing: Fiscal Year 2002 Summary: The Long QT Syndrome (LQTS) is a group of diseases in which patients have prolongation of the QT interval on the electrocardiogram (ECG). This interval represents repolarization of the heart. These patients are at risk of death due to a syndrome that has a genetic basis in most individuals. Genetic typing can identify patients and family members at risk of development of this syndrome. This is important because therapy is available which can effectively treat this problem and significantly reduce the mortality. This protocol will study patients with suspected LQTS and their families by performing a medical history, and ECG and a 24-hour Holter monitoring. In addition, blood will be drawn for analysis of the genetic structure. Subjects will also under go a noninvasive test called T wave alternans analysis, which involves wearing adhesive electrodes for approximately 30 minutes during rest and mild exercise, while a computer detects and quantifies subtle abnormalities of the T wave. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: OPIOID INDUCED POSTOPERATIVE SLEEP DISTURBANCES Principal Investigator & Institution: Cronin, Arthur; Pennsylvania State Univ Hershey Med Ctr 500 University Dr Hershey, Pa 17033 Timing: Fiscal Year 2002 Summary: This study will test the hypothesis that opioids contribute to postoperative sleep disturbance. Additionally, this study will determine whether the adverse effects of sleep disturbance on the cardiovascular, respiratory and central nervous systems are less pronounced in patients treated with regional local anesthetic instead of opioids for postoperative pain control. Finally the hormone condition corresponding to sleep disruption will be examined to evaluate the influence of stress hormones and the response of melatonin, a hormone controlled by the circadian rhythym. The primary aim is to determine if opioids contribute to postoperative sleep disturbance. Patients undergoing abdominal hysterectomy will be randomly assigned to receive epidural opioid or local anesthetic for postoperative pain control. The patients' sleep will be monitored on the night before surgery and on the first three posoperative nights by recording the electroencephalogram and electromyogram. For each patient the amount of REM sleep and NREM sleep on the preoperative night will be compared with the amounts on the postoperative nights. We expect to observe greater differences before and after surgery in theses sleep stages in the opioid group, We expect preservation of a more normal sleep cycle in the local anesthetic group. Because surgical stress and pain are potential contributers to sleep disruption, we will measure stress hormones in the urine (catecholamines and cortisol) and blood (interleukin-1) as well as record the patients' subjective rating of their pain. The second aim is to determine if postoperative sleep disturbance is clinically significant. Studies have shown that sleep deprivation with consequent REM rebound can cause impaired cognitive performance, breathing disturbance, and hemodynamic instability. Daily tests of cognitive function and overnight recordings of respiratory rate, arterial oxygen saturation, blood pressure and the electrocardiogram will be performed. We hypothesize that the complications of sleep deprivation demonstrated in normal volunteers will occur in postoperative patients who are already under intense physiologic stress. The final aim is to test the hypothesis that melatonin, a hormone controlled by the circadian rhythym, will be

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supressed during the nights of sleep deprivation. Abnormally low levels of melatonin have been measured in elderly insomniacs, and administration of melatonin to these patients has improved their sleep. If postoperative sleep distruption is associated with abnormally low levels of melatonin in the blood, then administration of melatonin might be a potential treatment for postoperative sleep disturbance. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PATHOGENESIS OF HERG MUTATIONS IN HUMAN LONG QT SYNDROME Principal Investigator & Institution: Zhou, Zhengfeng; Medicine; Oregon Health & Science University Portland, or 972393098 Timing: Fiscal Year 2002; Project Start 05-DEC-2001; Project End 30-NOV-2005 Summary: (provided by applicant): Congenital long QT syndrome (LQTS) is a disease associated with delayed cardiac repolarization and prolonged QT intervals on the electrocardiogram, which can lead to ventricular arrhythmia with cardiac sudden death. One of the major forms of LQTS (LQT2) is caused by mutations in the human ether-ago-go-related gene (HERG) that encodes the rapidly activating delayed rectifier potassium channel. To date, more than 100 HERG mutations have been identified in patients with LQTS. Our previous work has shown that a major mechanism for loss of HERG channel function in LQT2 is defective protein trafficking which results in failure of mutant channels to reach the cell surface. We also showed that high affinity HERG channel blockers can correct defective protein trafficking of some LQT2 mutants. The goals of this proposal are (1) to study the mechanisms of defective protein trafficking of LQT2 mutant channels, and (2) to determine how HERO channel blockers rescue trafficking defective LQT2 mutant channels. Our hypotheses are (1) LQT2 mutations cause misfolding or improper assembly of HERO protein which is recognized by quality control system leading to ER retention and degradation by the proteasome, and (2) drugs that bind to HERO channels with high affinity act as pharmacological chaperones to promote proper folding or assembly in a conformation that permits trafficking to the plasma membrane. We will test these hypotheses by four specific aims: aim I to determine whether LQT2 mutations cause misfolding or improper assembly of mutant channels; aim 2 to study the role of molecular chaperones in the ER retention of LQT2 mutant channels; aim 3 to investigate the mechanisms by which LQT2 mutants are recognized and degraded by the proteasome; and aim 4 to elucidate the mechanisms by which high affinity HERG channel blockers correct defective protein trafficking of LQT2 mutant channels. We will use a combination of biochemical, immunohistochemical and patch clamp techniques to study wild type HERG and LQT2 mutant channels expressed in transfected tissue culture cells and in cell-free systems. These studies will strengthen our knowledge of how misfolded and improperly assembled LQT2 mutant channels are recognized, retained and degraded by the ER quality control system and how HERG channel blockers modify these processes and rescue LQT2 mutant channels. Elucidating these mechanisms is an important step towards the development of pharmacological strategies for therapies of congenital LQTS. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PATHOGENESIS OF SYSTEMIC RESPONSES TO METALS IN FUEL OIL ASH Principal Investigator & Institution: Godeski, John J.; Harvard University (Sch of Public Hlth) Public Health Campus Boston, Ma 02115

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Timing: Fiscal Year 2002 Summary: Vanadium and other transition metals are listed as inorganic superfund target chemicals, known to have toxic health effects, and found at Superfund Sites. Inhalation is the usual route of entry into the human body for these chemicals. The ultimate chemical species of metal to enter cells relates to its chemical form in environmental particles as well as the fluid media encountered in tissues. Fuel oil ash is a frequent source of transition metal pollutants at supr fund sites. Several important observations have emerged in our studies to date: Namely, 1) Inhalation of fly ash particles results in both entry into pulmonary cells with constituent interactions in the lung as well as documented entry of metal particles into cells in other organs; 2) Cell responses such as induction of pro-inflammatory chemokines are observed in the lung as well as other organs, most notably the heart; and 3) Functional changes in the heart, as measured with the electrocardiogram, indicate an increasing tendency toward life threatening cardiac electrical vulnerability. Although relatively soluble forms of inhaled particles are expected to easily pass from the pulmonary surface to lymphatics and blood and thus by systemically distributed, the route(s) by which particulate forms may be systemically distributed is less clear. Indeed, recent speculation suggests that the irritant toxicity of the inhaled particles may cause an increase in translocation of particles to the systemic circulation. Studies in the renewal of this project will focus upon mechanisms of particle translocation from the lung and critical responses to these particles by the heart and other organs of the body. Specific aims of this project are: 1) To determine mechanisms of cardiac responses to inhalation of metal-rich fuel oil ash and to determine the relationship of these mechanisms to the electrocardiographic abnormalities observed in exposed animals; and 2) To quantify the translocation of radioactive trace particles form the lung to the heart and other systemic locations and to determine role of fly ash constituents in facilitating this process. Biochemical, physiologic, and molecular approaches will be used to define mechanisms of toxicity. The novel application of these sophisticated technologies in our proposed studies will offer new insights into mechanisms of toxicity of transition metals in fuel oil ash. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PRIMARY PREVENTION TRIAL Principal Investigator & Institution: Saad, Mohammed F.; Professor; Medicine; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, Ca 90024 Timing: Fiscal Year 2002; Project Start 20-AUG-1994; Project End 14-MAY-2003 Summary: Non-insulin-dependent diabetes mellitus (NIDDM) is a major health problem affecting approximately 14 million Americans. It causes significant morbidity and mortality and imposes a great economic burden as the annual cost of diabetes currently exceeds $20 billion. Moreover, the socioeconomic effects of NIDDM are expected to escalate with the increase in its prevalence due to aging of the American society and rapid growth of minority populations at high risk for the disease. Since most of the morbidity and mortality of NIDDM arise from its long-term complication, prevention and early detection of the disease should have a tremendous human, social, and economic impact. The major aim of this proposal is to test the hypothesis that intervention can prevent or delay the decompensation from impaired glucose tolerance (IGT) to NIDDM and the progression to fasting hyperglycemia in normoglycemic newly diagnosed NIDDM and possibly reduce the incidence of atherosclerotic cardiovascular (ASCVD). As part of the multicenter NIDDM primary prevention trial (DK- 93-07), we plan to study 200 obese (body mass index greater than or equal to 27kg/m2) subjects

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(100 whites, and 100 blacks) aged 40-65 years with persistent IGT or newly diagnosed NIDDM (with fasting normoglycemia) according to the World Health Organization criteria. They will be recruited from the population of Los Angeles served by Southern California Kaiser Permanente Foundation on the basis of fasting plasma glucose concentration measured during their routine health care. The proposed intervention is a 2x2 factorial design with one factor being a special low-fat diet and exercise program versus usual care and the second factor being a drug that improves insulin sensitivity (e.g., the biguanide metformin) versus placebo. The primary endpoints will be the development of NIDDM for subjects with IGT and worsening to fasting hyperglycemia for those with newly diagnosed NIDDM. The secondary endpoints will be changes in blood pressure, the concentrations of lipids, lipoproteins, fibrinogen, ad plasminogen activator inhibitor 1, and the development of ASCVD as assessed from the clinical data, the ankle/arm ratio, and the electrocardiogram. The success of this trial will have a great impact in alleviating human suffering and decreasing the socioeconomic effects of NIDDM. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PROSPECTIVE ASSESSMENT AFTER PEDIATRIC CARDIAC ABLATION Principal Investigator & Institution: Van Hare, George F.; Pediatrics; Stanford University Stanford, Ca 94305 Timing: Fiscal Year 2002; Project Start 01-MAY-1998; Project End 30-APR-2004 Summary: (Adapted from Investigator's Abstract) Radiofrequency catheter ablation is a catheterization laboratory technique for the cure of cardiac arrhythmias, which has become common in pediatric cardiology practice. Recent analyses have suggested that ablation therapy is more cost-effective compared not only with surgery, but also with antiarrhythmic medication. Despite a good initial success rate of the technique, and a low initial complication rate, there is concern about possible long-term effects with the technique in the pediatric age group. There are reports not only of damage to cardiac valves, but also the development of new arrhythmias, including sudden death, as a result of ablations in children. Recurrences are observed frequently following initially successful procedures. Finally, there are animal data to suggest that immature myocardium is more prone to severe damage as a result of ablation procedures. Few, if any, data exist to support the long-term safety of these ablation techniques in children. Therefore, before ablation therapy becomes the standard approach in children, it is important to carefully assess the long-term risks in this patient group. The application presents plans to conduct a multi-center, prospective, 5-year study to evaluate children undergoing catheter ablation at pediatric centers in North America. The collection of these data is intended to provide the following information: 1) the incidence of serious cardiac damage as a result of ablation; 2) the incidence and time course of recurrence after initially successful ablation; and 3) the incidence of proarrhythmia following ablation. A total of 450 pediatric patients will be enrolled prospectively and evaluated both before ablation of supraventricular tachycardia and at intervals following ablation with clinical history and examination, electrocardiogram, 24-hour Holter monitor, and echocardiogram, with non-invasive studies read by outside consultants. In addition, a complete Registry of pediatric patients undergoing ablation at the participating centers will be established to allow comparisons with the study group and to provide population estimates of success and complication rates. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: SCREENING--ASYMPTOMATIC LEFT VENTRICULAR SYSTOLIC DYSFUN Principal Investigator & Institution: Baker, David W.; Chief, Division of General Internal Medi; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106 Timing: Fiscal Year 2002 Summary: Previous studies have determined risk factors for developing heart failure, and some experts recommend using non-invasive testing to screen patients with risk factors for heart failure to identify patients with cardiac dysfunction before they develop heart failure. However, no studies have determined the feasiblity and yield of such screening. This study will estimate the prevalence of asymptomatic left ventricular systolic dysfunction (diminished force of contraction of the heart) in patients with risk factors( hypertension > 10 years, diabetes, coronary heart disease) for developing heart failure. Eligible patients will be offered an electrocardiogram and a limited echocardiogram. Heart failure has become a major public health problem, with approximately 3 million Americans having this condition. This study should help determine whether it is possible to screen patients with risk factors so they can be treated with medications that have been shown to slow or prevent the development of heart failure. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: HEMORRHAGE

THE

ELECTROCARDIOGRAM

IN

SUBARACHNOID

Principal Investigator & Institution: Sommargren, Claire E.; Physiological Nursing; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 941222747 Timing: Fiscal Year 2002; Project Start 24-SEP-2001; Project End 15-JUN-2003 Summary: A two-year program of training and research is proposed to study the frequency, characteristics, and clinical significance of electrocardiographic (ECG) abnormalities that occur during the acute phase of subarachnoid hemorrhage (SAH). SAH is a serious neurological disorder in which ECG abnormalities have been reported in patients without pre-existing cardiac disease. All prior investigations of this phenomenon were limited by incomplete ECG data obtained from either a single or daily 1 O-second ECG tracing or a single-lead rhythm strip. The proposed study will, for the first time, utilize newer computer assisted ECG technologies to collect continuous 12-lead ECG information during the entire intensive care period. The specific aims of the study will be to: 1) describe the types of ECG waveform abnormalities that occur in patients with SAH; 2) describe the frequency, duration, reversibility, and timing in the clinical course of these abnormalities; 3) investigate the relationship between ECG abnormalities and demographic, neurological, clinical, and outcomes variables; 4) explore which demographic, neurological, or clinical variables may predict the occurrence of ECG abnormalities; and 5) investigate which ECG abnormalities may predict unfavorable patient outcomes. A long-term goal of the applicant?s program of research is the development of a risk-stratification tool, based on ECG abnormalities, for patients with SAH. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: THE PATHOPHYSIOLOGY OF T-WAVE ALTERNANS Principal Investigator & Institution: Narayan, Sanjiv M.; Medicine; University of California San Diego 9500 Gilman Dr, Dept. 0934 La Jolla, Ca 920930934

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Timing: Fiscal Year 2002; Project Start 17-SEP-2001; Project End 31-AUG-2006 Summary: (provided by applicant) This Mentored Patient-Oriented Research Career Development Award application focuses on a program of research designed to study the intracardiac mechanisms underlying T-wave alternans (TWA) of the electrocardiogram in individuals with prior myocardial infarcts and depressed cardiac systolic function in order to improve its computation and therefore its ability to predict those who are at risk for ventricular tachycardia (VT) or fibrillation (VF). This work will build on the applicant?s prior research and training in clinical cardiology and invasive electro-physiology, as well as in basic science, computer science and numerical methods. The proposed research will test the hypothesis that programmed ventricular stimulation in patients with ischemic heart disease and left ventricular dysfunction induces proarrhythmic nonuniformities in ventricular repolarization, and results in redistribution of TWA late in the T-wave, and TWA phase reversal, that are detectable by novel analyses of the ECG. There are two specific aims: 1) To establish that an increased magnitude of TWA late in the T-wave and TWA phase reversal parallel changes in the endocardial dispersion of ventricular repolarization measured, using monophasic action potentials, during progressive programmed ventricular stimulation leading to the induction of VT/VF. 2) To prospectively test, in patients with ischemic heart disease and left ventricular dysfunction, the performance of a new index of myocardial electrical instability, derived from the data calibrating TWA late magnitude and phase to the dispersion of monophasic action potential duration obtained in the research performed to fulfill Specific Aim 1, in predicting the incidence of spontaneous VT/VF. The applicant will perform this work under the supervision and guidance of his Mentor, and with guidance from a Scientific Advisory Committee comprising experts in basic and clinical electrophysiology, in the interpretation of monophasic action potentials, in numeric modeling and signal processing, in statistics and in clinical research. This structured approach will ensure the successful completion of this project and, in this way, the development of the applicant into an independent clinicianinvestigator. 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 “electrocardiogram” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for electrocardiogram in the PubMed Central database:

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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A markup language for electrocardiogram data acquisition and analysis (ecgML). by Wang H, Azuaje F, Jung B, Black N.; 2003; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=161810

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Interpreting Electrocardiograms Using Basic Principles and Vector Concepts. by Vaisman D.; 2001; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=101220

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Method for non-invasively recording electrocardiograms in conscious mice. by Chu V, Otero JM, Lopez O, Morgan JP, Amende I, Hampton TG.; 2001; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=35354

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Twelve-Lead Electrocardiogram of Torsades de Pointes. by Khan IA.; 2001; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=101137

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Ventricular beat detection in single channel electrocardiograms. by Dotsinsky IA, Stoyanov TV.; 2004; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=356927

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

A new Q/QS pattern on the resting electrocardiogram is associated with impaired insulin secretion and a poor prognosis in elderly men independently of history of myocardial infarction. Author(s): Dunder K, Lind L, Zethelius B, Lithell H. Source: Journal of Internal Medicine. 2004 February; 255(2): 221-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14746559&dopt=Abstract

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A totally occluded right coronary artery presenting with a normal electrocardiogram. Author(s): Nanavati VI, Knapp AL, Passelaqua S. Source: J Invasive Cardiol. 2003 June; 15(6): 355-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12777678&dopt=Abstract

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

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Acute pericarditis: classic electrocardiogram. Author(s): Spodick DH. Source: The American Journal of Geriatric Cardiology. 2003 July-August; 12(4): 266. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12888710&dopt=Abstract

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Ambulatory electrocardiogram-based tracking of T wave alternans in postmyocardial infarction patients to assess risk of cardiac arrest or arrhythmic death. Author(s): Verrier RL, Nearing BD, La Rovere MT, Pinna GD, Mittleman MA, Bigger JT Jr, Schwartz PJ; ATRAMI Investigators. Source: Journal of Cardiovascular Electrophysiology. 2003 July; 14(7): 705-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12930249&dopt=Abstract

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Are family practice residents able to interpret electrocardiograms? Author(s): Boltri JM, Hash RB, Vogel RL. Source: Advances in Health Sciences Education : Theory and Practice. 2003; 8(2): 149-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12913374&dopt=Abstract

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Ask the doctor. I am a fit and healthy 42-year-old man. So I was disturbed when my latest electrocardiogram said I had “ST elevation consistent with early repolarization.” I know from reading the Heart Letter that ST elevation can mean a heart attack, although I don't think I have had one of these. Should I be worried about this? Author(s): Lee TH. Source: Harvard Heart Letter : from Harvard Medical School. 2003 December; 14(4): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14690988&dopt=Abstract

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Automated processing of the single-lead electrocardiogram for the detection of obstructive sleep apnoea. Author(s): de Chazal P, Heneghan C, Sheridan E, Reilly R, Nolan P, O'Malley M. Source: Ieee Transactions on Bio-Medical Engineering. 2003 June; 50(6): 686-96. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12814235&dopt=Abstract

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Basic electrocardiogram interpretation for perioperative nurses. Author(s): Hutchisson B, Cossey S, Wheeler RM. Source: Aorn Journal. 2003 October; 78(4): 572-81, 585-90; Quiz 591-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14575183&dopt=Abstract

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Beat-to-beat repolarisation variability in body surface electrocardiograms. Author(s): Avbelj V, Trobec R, Gersak B. Source: Medical & Biological Engineering & Computing. 2003 September; 41(5): 556-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14572006&dopt=Abstract

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Can P wave parameters obtained from 12-lead surface electrocardiogram be a predictor for atrial fibrillation in patients who have structural heart disease? Author(s): Altunkeser BB, Ozdemir K, Gok H, Temizhan A, Tokac M, Karabag T. Source: Angiology. 2003 July-August; 54(4): 475-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12934768&dopt=Abstract

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Clinical and angiographic characteristics of patients with combined anterior and inferior ST-segment elevation on the initial electrocardiogram during acute myocardial infarction. Author(s): Sadanandan S, Hochman JS, Kolodziej A, Criger DA, Ross A, Selvester R, Wagner GS. Source: American Heart Journal. 2003 October; 146(4): 653-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14564319&dopt=Abstract

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Clinical information affects electrocardiogram interpretation and can influence patient entry type. Author(s): Ross GE. Source: J Am Osteopath Assoc. 2003 July; 103(7): 309-10. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12884940&dopt=Abstract

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Comparison of the 80-lead body surface map to physician and to 12-lead electrocardiogram in detection of acute myocardial infarction. Author(s): McClelland AJ, Owens CG, Menown IB, Lown M, Adgey AA. Source: The American Journal of Cardiology. 2003 August 1; 92(3): 252-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12888126&dopt=Abstract

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Computer decision support as a source of interpretation error: the case of electrocardiograms. Author(s): Tsai TL, Fridsma DB, Gatti G. Source: Journal of the American Medical Informatics Association : Jamia. 2003 September-October; 10(5): 478-83. Epub 2003 June 04. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12807810&dopt=Abstract

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Coronary artery disease diagnosis based on exercise electrocardiogram indexes from repolarisation, depolarisation and heart rate variability. Author(s): Bailon R, Mateo J, Olmos S, Serrano P, Garcia J, del Rio A, Ferreira IJ, Laguna P. Source: Medical & Biological Engineering & Computing. 2003 September; 41(5): 561-71. Erratum In: Med Biol Eng Comput. 2003 November; 41(6): 746. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14572007&dopt=Abstract

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Detection of incipient left ventricular hypertrophy in mild to moderate arterial hypertension with normal electrocardiogram and echocardiogram: a new use for signal-averaged electrocardiography. Author(s): Ginefra P, Barbosa EC, Barbosa PR, Bomfim AS, Boghossian SH, Salgado AA, Brasil FG, Freitas EA, Albanesi Filho FM. Source: Arquivos Brasileiros De Cardiologia. 2003 July; 81(1): 79-84, 73-8. Epub 2003 July 31. English, Portuguese. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12908075&dopt=Abstract

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Disappearance of the Brugada-type electrocardiogram after surgical castration: a role for testosterone and an explanation for the male preponderance. Author(s): Matsuo K, Akahoshi M, Seto S, Yano K. Source: Pacing and Clinical Electrophysiology : Pace. 2003 July; 26(7 Pt 1): 1551-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12914638&dopt=Abstract

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Electrocardiogram in centenarians. Author(s): Klich-Raczka A, Zyczkowska J, Grodzicki T. Source: Kardiologia Polska. 2003 April; 58(4): 275-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14517559&dopt=Abstract

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Emergency medicine residency training in electrocardiogram interpretation. Author(s): Ginde AA, Char DM. Source: Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine. 2003 July; 10(7): 738-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12837648&dopt=Abstract

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Evaluation of electrocardiogram T-wave dispersion measurement methods. Author(s): Lund K, Lund B, Brohet C, Nygaard H. Source: Medical & Biological Engineering & Computing. 2003 July; 41(4): 410-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12892363&dopt=Abstract

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Evaluation of the arrhythmogenecity of stress-induced “Takotsubo cardiomyopathy” from the time course of the 12-lead surface electrocardiogram. Author(s): Matsuoka K, Okubo S, Fujii E, Uchida F, Kasai A, Aoki T, Makino K, Omichi C, Fujimoto N, Ohta S, Sawai T, Nakano T. Source: The American Journal of Cardiology. 2003 July 15; 92(2): 230-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12860233&dopt=Abstract

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Feedback intervention to reduce routine electrocardiogram use in primary care. Author(s): Stafford RS. Source: American Heart Journal. 2003 June; 145(6): 979-85. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12796752&dopt=Abstract

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Fetal electrocardiogram (ECG) for fetal monitoring during labour. Author(s): Neilson JP. Source: Cochrane Database Syst Rev. 2003; (2): Cd000116. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12804387&dopt=Abstract

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Frequency measures obtained from the surface electrocardiogram in atrial fibrillation research and clinical decision-making. Author(s): Bollmann A, Husser D, Stridh M, Soernmo L, Majic M, Klein HU, Olsson SB. Source: Journal of Cardiovascular Electrophysiology. 2003 October; 14(10 Suppl): S15461. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14760918&dopt=Abstract

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High-amplitude QRS complex in the electrocardiograms of normotensive people and risk of subsequent hypertension. Author(s): Takeda Y, Fukutomi T, Suzuki S, Murasaki G, Okutani H, Makoto I. Source: International Journal of Cardiology. 2003 September; 91(1): 37-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12957727&dopt=Abstract

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How do you interpret a 12-lead electrocardiogram (ECG)? Author(s): Hahn P. Source: Critical Care Nurse. 2003 October; 23(5): 58-60. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14606128&dopt=Abstract

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Impacting the use of the screening electrocardiogram. Author(s): Cuffe MS. Source: American Heart Journal. 2003 June; 145(6): 936-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12796745&dopt=Abstract

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Novel Left Ventricular Assist System: an electrocardiogram-synchronized LVAS that avoids cardiac cannulation. Author(s): Liotta D. Source: Texas Heart Institute Journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital. 2003; 30(3): 194-201. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12959201&dopt=Abstract

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Prediction of early recurrence of atrial fibrillation after external cardioversion by means of P wave signal-averaged electrocardiogram. Author(s): Ehrlich JR, Schadow K, Steul K, Zhang GQ, Israel CW, Hohnloser SH. Source: Zeitschrift Fur Kardiologie. 2003 July; 92(7): 540-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12883838&dopt=Abstract

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Prediction of significant left main coronary artery stenosis by the 12-lead electrocardiogram in patients with rest angina pectoris and the withholding of clopidogrel therapy. Author(s): Gaitonde RS, Sharma N, Ali-Hasan S, Miller JM, Jayachandran JV, Kalaria VG. Source: The American Journal of Cardiology. 2003 October 1; 92(7): 846-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14516891&dopt=Abstract

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Quantitative comparison of spontaneous and paced 12-lead electrocardiogram during right ventricular outflow tract ventricular tachycardia. Author(s): Gerstenfeld EP, Dixit S, Callans DJ, Rajawat Y, Rho R, Marchlinski FE. Source: Journal of the American College of Cardiology. 2003 June 4; 41(11): 2046-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12798580&dopt=Abstract

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Recording electrocardiograms can be dangerous. Author(s): Peters J. Source: Anesthesiology. 2003 November; 99(5): 1225-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14576564&dopt=Abstract

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Relation of CTG expansion and clinical variables to electrocardiogram conduction abnormalities and sudden death in patients with myotonic dystrophy. Author(s): Sabovic M, Medica I, Logar N, Mandic E, Zidar J, Peterlin B. Source: Neuromuscular Disorders : Nmd. 2003 December; 13(10): 822-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14678805&dopt=Abstract

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Reliability of QRS duration and morphology on surface electrocardiogram to identify ventricular dyssynchrony in patients with idiopathic dilated cardiomyopathy. Author(s): Fauchier L, Marie O, Casset-Senon D, Babuty D, Cosnay P, Fauchier JP. Source: The American Journal of Cardiology. 2003 August 1; 92(3): 341-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12888151&dopt=Abstract

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Sudden cardiac death in the young in Sweden: electrocardiogram in relation to forensic diagnosis. Author(s): Wisten A, Andersson S, Forsberg H, Krantz P, Messner T. Source: Journal of Internal Medicine. 2004 February; 255(2): 213-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14746558&dopt=Abstract

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Temporal abstraction and inductive logic programming for arrhythmia recognition from electrocardiograms. Author(s): Carrault G, Cordier MO, Quiniou R, Wang F. Source: Artificial Intelligence in Medicine. 2003 July; 28(3): 231-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12927335&dopt=Abstract

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The duration of systole in an electrocardiogram in normal humans and in patients with heart disease. 1920. Author(s): Fridericia LS. Source: Annals of Noninvasive Electrocardiology : the Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc. 2003 October; 8(4): 343-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14516292&dopt=Abstract

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The early repolarization normal variant electrocardiogram: correlates and consequences. Author(s): Klatsky AL, Oehm R, Cooper RA, Udaltsova N, Armstrong MA. Source: The American Journal of Medicine. 2003 August 15; 115(3): 171-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12935822&dopt=Abstract

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The effect of QRS cancellation on atrial fibrillatory wave signal characteristics in the surface electrocardiogram. Author(s): Xi Q, Sahakian AV, Swiryn S. Source: Journal of Electrocardiology. 2003 July; 36(3): 243-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12942487&dopt=Abstract

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The electrocardiogram as a predictor of left ventricular systolic function: correlation with gated SPECT imaging. Author(s): Henzlova MJ, Croft LB. Source: The Mount Sinai Journal of Medicine, New York. 2003 October; 70(5): 306-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14631516&dopt=Abstract

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The electrocardiogram in acute myocardial infarction. Author(s): Madias JE. Source: The New England Journal of Medicine. 2003 June 5; 348(23): 2362; Author Reply 2362. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12789007&dopt=Abstract

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The electrocardiogram in ST elevation acute myocardial infarction: correlation with coronary anatomy and prognosis. Author(s): Birnbaum Y, Drew BJ. Source: Postgraduate Medical Journal. 2003 September; 79(935): 490-504. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=13679544&dopt=Abstract

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The impact of EHR and digital electrocardiograms. Author(s): Bruun-Rasmussen M, Kaae T, Tynan L, Chronaki CE. Source: Stud Health Technol Inform. 2003; 95: 257-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14663996&dopt=Abstract

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The usefulness of surface 12-lead electrocardiogram to predict intra-atrial conduction block after successful atrial flutter ablation. Author(s): Mairesse GH, Lacroix D, Klug D, Le Franc P, Kouakam C, Kacet S. Source: Journal of Electrocardiology. 2003 July; 36(3): 227-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12942485&dopt=Abstract

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Utility of a combined signal-averaged electrocardiogram and QT dispersion algorithm in identifying arrhythmogenic right ventricular dysplasia in patients with tachycardia of right ventricular origin. Author(s): Nasir K, Bomma C, Khan FA, Tandri H, Tichnell C, James C, Rutberg J, Berger R, Calkins H. Source: The American Journal of Cardiology. 2003 July 1; 92(1): 105-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12842263&dopt=Abstract

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Ventricular repolarization components on the electrocardiogram: cellular basis and clinical significance. Author(s): Yan GX, Lankipalli RS, Burke JF, Musco S, Kowey PR. Source: Journal of the American College of Cardiology. 2003 August 6; 42(3): 401-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12906963&dopt=Abstract

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Wigner-Ville analysis and classification of electrocardiograms during thrombolysis. Author(s): Chouvarda I, Maglaveras N, Boufidou A, Mohlas S, Louridas G. Source: Medical & Biological Engineering & Computing. 2003 November; 41(6): 609-17. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14686585&dopt=Abstract

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

Finding Nutrition Studies on Electrocardiogram 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 “electrocardiogram” (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 information is typical of that found when using the “Full IBIDS Database” to search for “electrocardiogram” (or a synonym): •

A case in which the vagus influenced the form of the ventricular complex of the electrocardiogram. 1915. Source: Wilson, Frank N Ann-Noninvasive-Electrocardiol. 2002 April; 7(2): 153-73 1082720X

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An improved method to correct the QT interval of the electrocardiogram for changes in heart rate. Author(s): Department of Cardiovascular Pharmacology, Janssen Research Foundation,Beerse, Belgium. Source: Van de Water, A Verheyen, J Xhonneux, R Reneman, R S J-Pharmacol-Methods. 1989 November; 22(3): 207-17 0160-5402

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Arsenic trioxide therapy for relapsed or refractory Japanese patients with acute promyelocytic leukemia: need for careful electrocardiogram monitoring. Author(s): Department of Medicine III, Hamamatsu University School of Medicine, Handayama, Hamamatsu, Japan. Source: Ohnishi, K Yoshida, H Shigeno, K Nakamura, S Fujisawa, S Naito, K Shinjo, K Fujita, Y Matsui, H Sahara, N Takeshita, A Satoh, H Terada, H Ohno, R Leukemia. 2002 April; 16(4): 617-22 0887-6924

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Effect of artemether on electrocardiogram in severe falciparum malaria. Author(s): Clinical Pharmacology Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. Source: Karbwang, J Laothavorn, P Sukontason, K Thiha, T Rimchala, W Na Bangchang, K Bunnag, D Southeast-Asian-J-Trop-Med-Public-Health. 1997 September; 28(3): 472-5 0038-3619

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Effect of garlic on serum cholesterol and electrocardiogram of rabbit consuming normal diet. Source: Gupta, P P Khetrapal, P Ghai, C L Indian-J-Med-Sci. 1987 January; 41(1): 6-11 0019-5359

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Effect of parasympathetic blockade on the signal-averaged electrocardiogram. Author(s): Department of Cardiology, Skejby Sygehus, University Hospital, Aarhus, Denmark. [email protected] Source: Christiansen, E H Frobert, O Clin-Auton-Res. 1998 June; 8(3): 165-71 0959-9851

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Effect of vitamin D deficiency on electrocardiogram of rats. Author(s): Department of Physiology, Medical College, Rohtak, India. Source: Sood, S Reghunandanan, R Reghunandanan, V Gopinathan, K Sood, A K Indian-J-Exp-Biol. 1995 January; 33(1): 61-3 0019-5189

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Electrocardiogram pattern in hypercholesterolemic women: the influence of hormone replacement therapy. Author(s): Department of Obstetrics and Gynecology, Lund University Hospital, Lund, Sweden. Source: Akerblom, M Li, C Samsioe, G Climacteric. 1998 December; 1(4): 258-63 13697137

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Ischemic change on electrocardiogram induced by hypoglycemia in a diabetic patient. Author(s): Department of Internal Medicine, Nanasato Hospital, Saitama, Japan. Source: Matsunaga, R Miura, J Fujito, T Uchigata, Y Inoue, T Kamishirado, H Morooka, S Omori, Y Jpn-Circ-J. 1998 February; 62(2): 142-5 0047-1828

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Method for stable measurement of the electrocardiogram in isolated guinea pig heart. Evaluation of the RR-QT relationship and the effect of quinidine. Source: Uematsu, T Vozeh, S Ha, H R Follath, F Nakashima, M J-Pharmacol-Methods. 1987 September; 18(2): 179-85 0160-5402

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New Q waves on the presenting electrocardiogram independently predict increased cardiac mortality following a first ST-elevation myocardial infarction. Author(s): Cardiovascular Research Unit, Cardiology Department, Green Lane Hospital, Auckland, New Zealand. Source: Andrews, J French, J K Manda, S O White, H D Eur-Heart-J. 2000 April; 21(8): 647-53 0195-668X

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Pulmonary arterial pressure and electrocardiograms in broiler chickens infused intravenously with L-NAME, an inhibitor of nitric oxide synthase, or sodium nitroprusside (SNP), a nitric oxide donor. Author(s): College of Veterinary Medicine, Nanjing Agricultural University, China. Source: Weidong, S Xiaolong, W Jinyong, W Ruiping, X Br-Poult-Sci. 2002 May; 43(2): 306-12 0007-1668

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Role of lead aVR in evaluation of 12-lead electrocardiogram. Author(s): Department of Medicine, Creighton University School of Medicine, Omaha, NE 68131-2044, USA. Source: Siddiqui, M A Khan, I A Angiology. 2002 Nov-December; 53(6): 709-13 00033197

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Short-term drug effects on the signal-averaged electrocardiogram in healthy men: assessment of intra- and interindividual variability of spectral temporal mapping and time-domain analysis. Author(s): Department of Clinical Pharmacology, Vienna University, Austria. Source: Wolzt, M Schmetterer, L Kastner, J Krejcy, K Zanaschka, G Unfried, C Eichler, H G J-Pharmacol-Exp-Ther. 1995 December; 275(3): 1375-81 0022-3565

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The effect of estrogen compared to estrogen plus progesterone on the exercise electrocardiogram. Author(s): Division of Cardiology, Department of Medicine, College of Physicians and Surgeons of Columbia University, New York, New York 10032, USA. [email protected] Source: Bokhari, S Bergmann, S R J-Am-Coll-Cardiol. 2002 September 18; 40(6): 1092-6 0735-1097

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The effect of hypericum extract on cardiac conduction as seen in the electrocardiogram compared to that of imipramine. Author(s): Department of General Psychiatry, ECG Laboratory, University Clinic, Essen, Germany. Source: Czekalla, J Gastpar, M Hubner, W D Jager, D Pharmacopsychiatry. 1997 September; 30 Suppl 286-8 0176-3679

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The orthogonal electrocardiogram in adult Nigerians: a preliminary report. Author(s): Department of Medicine, University of Ilorin, Nigeria. Source: Araoye, M A West-Afr-J-Med. 1992 Jan-March; 11(1): 48-54 0189-160X

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

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

•

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

•

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

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

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

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

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

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

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

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

Minerals Potassium Source: Integrative Medicine Communications; www.drkoop.com

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CHAPTER

3.

ALTERNATIVE MEDICINE ELECTROCARDIOGRAM

AND

Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to electrocardiogram. At the conclusion of this chapter, we will provide additional sources.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to electrocardiogram and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “electrocardiogram” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to electrocardiogram: •

“Herbal Ecstasy”: a case series of adverse reactions. Author(s): Yates KM, O'Connor A, Horsley CA. Source: N Z Med J. 2000 July 28; 113(1114): 315-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10972312&dopt=Abstract

•

“If you can't stand the heat, get out of the kitchen”. Author(s): Leppo JA. Source: The American Journal of Medicine. 1999 September; 107(3): 290-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10492326&dopt=Abstract

•

(N-3) fatty acids do not affect electrocardiographic characteristics of healthy men and women.

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Author(s): Geelen A, Brouwer IA, Zock PL, Kors JA, Swenne CA, Katan MB, Schouten EG. Source: The Journal of Nutrition. 2002 October; 132(10): 3051-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12368394&dopt=Abstract •

Accuracy and limitations of published algorithms using the twelve-lead electrocardiogram to localize overt atrioventricular accessory pathways. Author(s): Basiouny T, de Chillou C, Fareh S, Kirkorian G, Messier M, Sadoul N, Chevalier P, Magnin-Poull I, Blankoff I, Chen J, Touboul P, Aliot E. Source: Journal of Cardiovascular Electrophysiology. 1999 October; 10(10): 1340-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10515558&dopt=Abstract

•

Effects of spinal manipulative therapy on autonomic activity and the cardiovascular system: a case study using the electrocardiogram and arterial tonometry. Author(s): Driscoll MD, Hall MJ. Source: Journal of Manipulative and Physiological Therapeutics. 2000 October; 23(8): 545-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11050611&dopt=Abstract

•

The effect of hypericum extract on cardiac conduction as seen in the electrocardiogram compared to that of imipramine. Author(s): Czekalla J, Gastpar M, Hubner WD, Jager D. Source: Pharmacopsychiatry. 1997 September; 30 Suppl 2: 86-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9342766&dopt=Abstract

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Transcutaneous electrical nerve stimulation (TENS): an unusual source of electrocardiogram artefact. Author(s): Marples IL. Source: Anaesthesia. 2000 July; 55(7): 719-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10919460&dopt=Abstract

•

Transcutaneous electrical nerve stimulator-induced electrocardiogram artifact. A brief report. Author(s): Sliwa JA, Marinko MS. Source: American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists. 1996 July-August; 75(4): 307-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8777027&dopt=Abstract

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

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

Alternative Medicine 43

•

AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

•

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

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

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

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

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

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

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

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

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

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

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

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

General Overview Angina Source: Healthnotes, Inc.; www.healthnotes.com Angina Source: Integrative Medicine Communications; www.drkoop.com Anorexia Nervosa Source: Integrative Medicine Communications; www.drkoop.com Anxiety Source: Integrative Medicine Communications; www.drkoop.com Asthma Source: Integrative Medicine Communications; www.drkoop.com Cardiac Arrhythmia Source: Healthnotes, Inc.; www.healthnotes.com Congestive Heart Failure Source: Integrative Medicine Communications; www.drkoop.com Fainting Source: Integrative Medicine Communications; www.drkoop.com

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Heart Attack Source: Integrative Medicine Communications; www.drkoop.com Hyperkalemia Source: Integrative Medicine Communications; www.drkoop.com Myocardial Infarction Source: Integrative Medicine Communications; www.drkoop.com Pericarditis Source: Integrative Medicine Communications; www.drkoop.com Pulmonary Edema Source: Integrative Medicine Communications; www.drkoop.com Sarcoidosis Source: Integrative Medicine Communications; www.drkoop.com Stroke Source: Integrative Medicine Communications; www.drkoop.com Syncope Source: Integrative Medicine Communications; www.drkoop.com •

Alternative Therapy Chelation Therapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,679,00.html

•

Herbs and Supplements Astragalus Mem Alternative names: Huang-Qi; Astragalus membranaceus Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

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CHAPTER 4. DISSERTATIONS ON ELECTROCARDIOGRAM Overview In this chapter, we will give you a bibliography on recent dissertations relating to electrocardiogram. 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 “electrocardiogram” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on electrocardiogram, we have not necessarily excluded non-medical dissertations in this bibliography.

Dissertations on Electrocardiogram 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 electrocardiogram. 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: •

Psychological Effects on the Post-Exercise Electrocardiogram by Scher, Hal Brian; PhD from University of Toronto (Canada), 1988 http://wwwlib.umi.com/dissertations/fullcit/NL46363

•

Two-Dimensional Echocardiogram and Twelve Lead Electrocardiogram Differences between Active Women and Inactive Women by Hutcherson, Diana Sullivan, PhD from Indiana University, 1986, 68 pages http://wwwlib.umi.com/dissertations/fullcit/8628030

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 5. PATENTS ON ELECTROCARDIOGRAM Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.8 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “electrocardiogram” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on electrocardiogram, we have not necessarily excluded non-medical patents in this bibliography.

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

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

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

Apparatus for recording an electrocardiogram Inventor(s): Danteny; Alain (Sausset-les-Pins, FR), Piloy; Alain (Marseille, FR), Scalisi; Gerard (Paris, FR) Assignee(s): Sanimat Diffusion S.a. (fr) Patent Number: 6,363,274 Date filed: July 26, 2000 Abstract: Apparatus for recording an electrocardiogram including: a portable housing; and an analyzer which acquires, processes and stores electrical signals delivered by electrodes positioned on the housing such that the electrodes may be applied to a patient's thorax, and wherein the housing has a first series of three metallic electrodes positioned for application on the patient's thorax to acquire three precordial signals, a second series of two metallic electrodes positioned on the housing so that the patient's fingers may be applied thereon, to acquire two peripheral signals, and a skin electrode to acquire a third peripheral signal, connected to the housing by a connecting cable. Excerpt(s): The present invention relates to the field of electrocardiography. More particularly, the invention concerns a portable apparatus or device for recording an electrocardiogram. The general principle of such devices is, in particular, known from French patent FR2645005. FR'005 describes a device for successively recording a control electrocardiogram and a second electrocardiogram from a patient, then comparing the electrocardiograms after having transmitted them to a remote computer. The device described in FR'005 requires installation of a plurality of electrodes connected to the housing via cords. The electrodes must be fixed on the body by bracelets or similar means. The relevance of such a device is mainly related to alleged seizure situations. This enables a patient to record by himself, an emergency electrocardiogram, without the presence or aid of medical personnel. However, it is important that handling the device be simplified to the utmost. Indeed, when the patient recognizes signs of a seizure, or believes that he has recognized such signs, it is desirable that the handling operation be very simple to perform. The device from the prior art is not entirely satisfactory in this respect. Actually, this requires positioning of three electrodes on three distinct parts of the patient's body, possibly plugging the connection sockets of the cords connecting the electrodes to the portable housing and handling the device to which several cables of about a length of one meter are connected. Web site: http://www.delphion.com/details?pn=US06363274__

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Axis shift analysis of electrocardiogram signal parameters especially applicable for multivector analysis by implantable medical devices, and use of same Inventor(s): Nelson; Shannon (Stacy, MN), Stadler; Robert W. (Shoreview, MN) Assignee(s): Medtronic, Inc. (minneapolis, Mn) Patent Number: 6,397,100 Date filed: October 1, 2001 Abstract: We show how to determine whether there has been an axis shift in an electrocardiogram waveform and how to use this for filtering out bad

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electrocardiogram information and to modify an adaptive filter that can be used to adapt the filtering of such electrocardiogram information to make it available for determining physiologic conditions even after an axis shift. Excerpt(s): This invention relates to a method and apparatus embodied in an implantable medical device (IMD) or an external medical device (EMD) for monitoring electrocardiogram signals and potentially for finding myocardial ischemia of a patient's heart and optionally applying a therapy to a patient experiencing ischemia. Accurate and rapid detection of myocardial ischemia is the first essential step toward reducing morbidity and mortality from this often silent but deadly condition. Without the knowledge of the condition, it cannot be treated. A wide range of therapies are known for the treatment of myocardial ischemia once it is detected, including surgical revascularization, neural stimulation and a variety of biologically active agents or compounds which can remove blood clots, reduce cardiac workload or improve cardiac circulation. The electrocardiogram (ECG) or electrogram (EGM) of the cardiac cycle detected across sense electrode pairs located on the patient's skin or in the patient's body, respectively, is a repetitive waveform characterized by a periodic PQRST electrical activation sequence of the upper and lower heart chambers. The PQRST sequence is associated with the sequential depolarization and contraction of the atria followed by the depolarization and contraction of the ventricles, and successive PQRST complexes are separated by a baseline or isoelectric region. The PQRST electrical activation sequence commences with the P-wave indicative of the depolarization and contraction of the atria and is followed by the QRS complex indicative of the depolarization and contraction of the ventricles. The T-wave at the termination of the ST segment time delay is associated with re-polarization of the ventricles. The PQRST electrical activation sequence with intact A-V activation detected across a sense electrode pair is fairly predictable in shape. The P-wave. R-wave and T-wave events occurring in sequence in the range of normal heart rates are usually readily recognized by visual examination of the external ECG or an EGM recorded by implanted electrodes that are correctly oriented with the depolarization waves. The P-wave and R-wave are readily sensed by sense amplifiers of a monitor or therapy delivery device coupled with appropriately placed sense electrode pairs. Web site: http://www.delphion.com/details?pn=US06397100__ •

EKG driven CT image reconstruction for cardiac imaging Inventor(s): Cesmeli; Erdogan (Clifton Park, NY) Assignee(s): General Electric Company (schenectady, Ny) Patent Number: 6,438,196 Date filed: June 28, 2001 Abstract: A method for reconstructing an image of a beating heart includes decomposing at least one electrocardiogram (EKG) RR interval, tagging projection data with cardiac phase information based on the decomposition, and reconstructing an image using the tagged data. Excerpt(s): This invention relates generally to computed tomography (CT) imaging, and more particularly to reliable cardiac imaging using a CT system. The dynamic nature of a heart, and temporal and spatial resolution requirements for reliable diagnosis, make cardiac imaging a challenging task for CT technology. Specifically, as a CT gantry rotates, the heart continues to beat and move, and projection data is collected at varying

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cardiac phases. Since projection data cannot be acquired instantaneously, so that the cardiac phase of the heart is known for each projection data set, electrocardiograph (EKG) data is collected to correlate, or `tag`, CT projection data with cardiac phase information. The cardiac phase information is obtained by dividing each cardiac cycle of the EKG signal into sections that represent the different cardiac phases. One cardiac cycle within an EKG signal is understood to be represented by the part of the signal plotted from one R peak to the next R peak, i.e., the RR interval. Typically, cardiac phases are determined by temporally dividing the RR interval in a linear fashion. There is an assumption that the duration of events in the RR interval scale linearly when the heart rate changes. However, when the heart rate changes, the different cardiac phases do not change linearly. Thus, temporal based, or linearly scaled, cardiac phase determination is not always accurate as the heart rate changes. Web site: http://www.delphion.com/details?pn=US06438196__ •

EKG recording electrode device Inventor(s): Takashina; Tsunekazu (4-14, Fukaeminamimachi 1-chome, Higashinada-ku, Kobe-shi, Hyogo-ken, JP) Assignee(s): None Reported Patent Number: 6,408,200 Date filed: August 7, 2000 Abstract: This invention is intended to provide an EKG recording electrode device which can be easily and quickly fitted to a patient without giving uncomfortable bodily sensations to the patient even if it is difficult to change the position of the patient, making it possible to properly take an electrocardiogram. An EKG recording electrode device comprises an electrode holder made of a sheet material having flexibility and a size suited for placing on an upper front part of a human body, and a plurality of electrodes attached to the electrode holder, each electrode including a contact portion having a curved surface on the side which comes into contact with a human skin. Excerpt(s): The present invention relates to an EKG recording electrode device which is used when taking an electrocardiogram in emergency cases, on-site or at a hospital, or in ordinary diagnosis at a hospital, for example. Conventionally, an electrocardiogram is taken with electrodes attached to the chest of a human body by a suction cup method in which the electrodes built in suction cups are attached to the body surface after pretreating it by applying jelly, for example, or by a tape method in which the electrodes are attached to by means of adhesive tape. These electrode attaching methods, however, are not suited for diagnosis of emergency cases because the time required for attaching the electrodes is long. Therefore, it makes difficult to record a standard 12-lead electrocardiogram in a short time when above electrode attaching methods are used. The suction cup method has such additional problems that too small a negative pressure in the suction cups would cause the electrodes to come off as a result of minor movements or perspiration of a patient and, on the contrary, too large a negative pressure in the suction cups could often cause subcutaneous bleeding in the chest wall of the patient. On the other hand, the tape method has such additional problems that it tends to cause skin redness due to the use of the adhesive tape and give uncomfortable bodily sensations to the patient when the adhesive tape is attached or detached. Web site: http://www.delphion.com/details?pn=US06408200__

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Electrocardiogram compass Inventor(s): Maher; Kevin (1231 Split Rail Dr., Boothwyn, PA 19061) Assignee(s): None Reported Patent Number: 6,694,636 Date filed: August 30, 2001 Abstract: The specification discloses a compass for obtaining measurements from an electrocardiogram tracing, the comprising a compass body, a display screen, compass legs pivotally connected to the body, and a computer operatively coupled to the display screen. The relative movement of the compass legs is translated into electronic signal information. The computer is adapted to receive the electronic signal information, and is further operative to convert the electronic signal information into physiological information to be displayed on the display screen. A power source powers the computer and display screen. Excerpt(s): The present invention relates generally to tools for measuring electrocardiogram tracings and determining various physiological information therefrom. Electrocardiogram tracings are graphic representations of electromotive forces generated within the heart of a patient, which electromotive forces are transmitted across the chest wall and sensed by electrodes fixed to the patient's body. The standard electrocardiogram tracing displays these electromotive forces using Cartesian graphing, where the vertical axis represents the strength of the electromotive force, and the horizontal axis represents the duration of the electromotive force (i.e., the time during which the force is measured). From this graphical information a physician can determine numerous physiological data, including the patient's heart rate, axis deviations of the electrical axis of the heart, hypertrophy of chambers, conduction abnormalities, etc. In most instances, electrocardiogram tracings are printed on graph paper comprising numerous minute boxes or squares. The common means of obtaining information from these tracings therefor consists of manually counting these boxes or squares, for instance with a common caliper or compass, a stylus, or other pointing implement. The measurements so obtained can then be input into known formulas for manual calculation of desired physiological data, including, for example, the QT.sub.c interval. However, this system is prone to inaccuracies and, thus, the production of flawed measurements and data. Web site: http://www.delphion.com/details?pn=US06694636__

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Electrocardiogram electrode patch Inventor(s): Byers; George Alexander (Milwaukee, WI), Lovejoy; David Anthony (Thiensville, WI), Mikula; Patricia J. (Thiensville, WI) Assignee(s): GE Medical Systems Information Technologies, Inc. (waukesha, Wi) Patent Number: 6,453,186 Date filed: April 13, 2001 Abstract: An electrocardiogram (ECG) electrode patch for attachment to a neonatal or infant patient. The ECG electrode patch includes a plurality of at least three electrodes coupled to a substrate. The plurality of at least three electrodes includes at least one electrode capable of measuring the electrical activity of the right side of the patient's

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heart. A plurality of electrical conductors are coupled to the plurality of electrodes and to the substrate. Excerpt(s): The invention relates to an electrocardiogram (ECG) electrode patch and more particularly to an ECG electrode patch for attachment to a neonatal or infant patient. For a standard twelve-lead ECG, ten electrodes are attached to the surface of the patient's body, with each electrode corresponding to a particular area of the patient's heart. Six of the ten electrodes (V1, V2, V3, V4, V5, and V6) are positioned on the left side of the patient's chest around the heart in order to detect the electrical activity of the left side of the patient's heart. Four of the ten electrodes are positioned on or near the patient's limbs. Specifically, the four limb electrodes are positioned on the right arm (RA), the left arm (LA), the right leg (RL), and the left leg (LL). To detect the electrical activity of portions of the patient's heart other than the left side of the patient's heart, additional electrodes may be attached to the patient. Three electrodes (V4R, V5R, and V6R), referred to collectively as the right-sided chest leads, may be positioned on the patient's chest to measure the electrical activity of the right side of the patient's heart. Placement of the V4R, V5R, and V6R electrodes on the right side of the patient's chest mirrors the placement of the V4, V5, and V6 electrodes on the left side of the patient's chest. Web site: http://www.delphion.com/details?pn=US06453186__ •

Electrocardiogram system for synthesizing leads and providing an accuracy measure Inventor(s): Meij; Simon H. (Mijnsheerenland, NL), Nelwan; Stefan P. (Rotterdam, NL) Assignee(s): Siemens Medical Solutions Usa, Inc. (malvern, Pa) Patent Number: 6,643,539 Date filed: April 27, 2001 Abstract: An electrocardiogram (ECG) system provides a set of ECG lead signals. The system includes a source of a subset of ECG lead signals. A synthesizer, coupled to the ECG lead signal source, generates a set of synthesized ECG lead signals from the subset of ECG lead signals. Data is also generated representing the accuracy of the set of synthesized ECG lead signals. Excerpt(s): The present invention relates to electrocardiogram (ECG) systems, and in particular to ECG systems which can provide synthesized signals corresponding to signals generated from electrodes which provide the actual ECG signals. However, such a system does not always operate in the ideal manner. Sometimes, electrodes slip on, or work loose from, a patient's body and produce a null signal, or produce signals which are otherwise degraded to the point of being unusable. Furthermore, the location on the patient's body at which one or more of the electrodes should be placed may be unavailable due to injury or surgery. In addition, under some circumstances it may be desirable to place an electrode at a location on the body different from the normally used locations. It is desirable under these conditions to still provide the signals needed to generate the 12 lead ECG. It is known that the signals representing the respective lead signals contain mutually redundant information. It is also known that, should one electrode be missing or malfunctioning, an appropriate combination of signals from the other electrodes and/or the other leads, which are available and functional, can be used to generate a synthesized signal which closely approximates the lead signal derived from the missing or malfunctioning electrode. To apply this technique, at least some portion of a full 12 lead ECG is recorded, during an analysis phase. The recorded signals

Patents 53

are then processed to generate a function, which may be applied to the lead signals which are available, to synthesize a lead signal which approximates the lead signal which is missing or distorted beyond use. During a synthesis phase, this function is then applied to the available ECG lead signals. Using this technique, a missing lead may be synthesized. Web site: http://www.delphion.com/details?pn=US06643539__ •

Electrocardiogram system for synthesizing leads and providing an accuracy measure Inventor(s): Meij; Simon H. (Mijnsheerenland, NL), Nelwan; Stefan P. (Rotterdam, NL) Assignee(s): Draeger Medical System, Inc. (danvers, Ma) Patent Number: 6,690,967 Date filed: August 3, 2001 Abstract: An electrocardiogram (ECG) system includes a database for containing a number of entries. Each entry contains data for synthesizing a 12 lead ECG from received ECG lead signals, and an accuracy measure of the synthesized 12 lead ECG signals. The received ECG lead signals may be missing one or more leads due to detachment of the corresponding electrode, or because the location on the patient is unavailable. The synthesized 12 lead ECG synthesizes the missing leads. Alternatively, the received 12 lead ECG may be derived from a patient in a different body position than a reference position. The synthesized 12 lead ECG translates the ECG to one for the patient in the reference body position. In addition, a synthesized lead signal may be compared to a received lead signal to detect anomalous signals. Excerpt(s): The present invention relates to electrocardiogram (ECG) systems, and in particular to ECG systems which can provide synthesized signals corresponding to signals generated from electrodes which provide the actual ECG signals. In some cases, signals from all ten electrodes, necessary for proper derivation of a 12 lead ECG, are not available. For example, sometimes, electrodes work loose from, or slip on, a patient's body and produce a null signal, or produce signals which are otherwise degraded to the point of being unusable. Furthermore, the location on the patient's body at which one or more of the electrodes should be placed may be unavailable due to injury or surgery. As another example, in non-critical monitoring or telemetry conditions, modules providing only five or six electrodes are provided, both for patient comfort and to minimize the signal processing required. In other cases, it may be desirable to place an electrode at a location on the body different from the normally used locations. For example, it may be desired to monitor the right side of the heart, or further around the left side. Web site: http://www.delphion.com/details?pn=US06690967__

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External defibrillator instruction system and method Inventor(s): Freeman; Curtis W. (Windham, NH) Assignee(s): Koninklijke Philips Electronics N.v. (eindhoven, Nl) Patent Number: 6,694,187 Date filed: June 23, 2000 Abstract: The present disclosure relates to a system and method for instructing a user as to how to treat a patient with a defibrillator. In use, electrocardiogram data of the

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patient is analyzed to determine whether a shockable condition exists. Normal heart function and asystole are distinguished where no shock is advisable, and the user is advised that the patient is in asystole where an asystole condition is detected. Through this method, the attending technician is notified not only that a shock is not advised, but whether the shock is not advised due to an asystole condition. Excerpt(s): The present disclosure relates to an external defibrillator instruction system and method. More particularly, the disclosure relates to an external defibrillator system and method which provides details as to the patient's condition to the attending technician during no shock situations. Defibrillators supply pulses of electricity to a patient's heart to convert ventricular arrhythmias, such as ventricular fibrillation and ventricular tachycardia, to normal heart rhythms through the processes of defibrillations and cardioversion, respectively. There arc two main classifications of defibrillators: external and implanted. Implanted defibrillators are surgically implanted into patients who have a high likelihood of needing electrotherapy in the future. Implanted defibrillators typically monitor the patient's heart activity and automatically supply electro-therapeutic pulses directly to the patient's heart when indicated. Thus, implanted defibrillators permit the patient to function in a somewhat normal fashion away from the watchful eye of medical personnel. External defibrillators send electrical pulses to the patient's heart through electrodes which are applied to the patient's torso. External defibrillators are useful in the emergency room, emergency medical vehicles, and in other situations where there may be an unanticipated need to provide electrotherapy to a patient on short notice. The advantage of external defibrillators is that they may be used on a patient as needed, and then subsequently moved to be used with another patient. Web site: http://www.delphion.com/details?pn=US06694187__ •

Implantable cardiac stimulation device, system and method which provides an electrogram signal having the appearance of a surface electrocardiogram Inventor(s): Bornzin; Gene A. (Simi Valley, CA), Bradley; Kerry (Glendale, CA), Florio; Joseph J. (La Canada, CA) Assignee(s): Pacesetter, Inc. (sylmar, Ca) Patent Number: 6,658,283 Date filed: September 25, 2001 Abstract: An implantable cardiac stimulation system and method provides an external display of a heart activity signal sensed internally by an implantable cardiac stimulation device which has the appearance of a surface EKG. The heart activity signal is sensed by the implanted device and is processed by the device or the external display to have frequency characteristics resembling that of a surface EKG. The heart activity signal to be displayed takes the form of an intracardiac electrogram signal with a low frequency roll-on of no greater than 0.4 Hz and a high frequency cutoff of no less than 20 Hz. This provides a heart activity signal for display which has the appearance and most attributes of a surface EKG. Excerpt(s): The present invention generally relates to an implantable cardiac device. The present invention more particularly relates to an implantable cardiac stimulation device and external display for displaying an electrogram which resembles a surface electrocardiogram. Implantable cardiac devices are well known in the art. They may take the form of implantable defibrillators or cardioverters which treat accelerated

Patents 55

rhythms of the heart such as fibrillation or implantable pacemakers which maintain the heart rate above a prescribed limit, such as, for example, to treat a bradycardia. Implantable cardiac devices are also known which incorporate both a pacemaker and a defibrillator. A pacemaker may be considered as having two major components. One component is a pulse generator which generates the pacing stimulation pulses and includes the electronic circuitry and the power cell or battery. The other component is the lead, or leads, which electrically couple the pacemaker to the heart. Web site: http://www.delphion.com/details?pn=US06658283__ •

Implantable responsive system for sensing and treating acute myocardial infarction and for treating stroke Inventor(s): Fischell; David R. (Fair Haven, NJ), Fischell; Robert E. (Dayton, MD), Fischell; Tim A. (Richland, MI) Assignee(s): Angel Medical Systems, Inc. (fair Haven, Nj) Patent Number: 6,468,263 Date filed: May 21, 2001 Abstract: Disclosed is a completely implantable system that can detect the occurrence of a myocardial infarction, i.e., a heart attack, and automatically inject a thrombolytic and/or anti-thrombogenic agent into the bloodstream to promptly dissolve the thrombus that caused the myocardial infarction and prevent the formation of additional thrombi. It is well known that a myocardial infarction can be detected from a patient's electrocardiogram by noting an ST segment voltage deviation. Upon detection of a myocardial infarction, an ST segment deviation electronic detection circuit within the implanted device can produce an output signal that can cause a thrombolytic and/or anti-thrombogenic agent contained within an implanted, pressurized reservoir to immediately and automatically release medications into the patient's bloodstream. A patient warning system is also provided by an audio alarm or an electrical tickle within the human body indicating that a myocardial infarction has been detected. An externally located part of the system, in the form of a patient operated initiator, can be used to trigger the release of medication as soon as a first sign of a stroke has been detected in order to prevent damage to brain tissue that would be caused by that stroke. Thus the system can be used to prevent trissue damage from either a myocardial infarction or a stroke. The implanted system can also send a radio message to an externally located receiver that automatically dials an emergency rescue team to take the patient to a hospital for continuing treatment of a myocardial infarction or a stroke. Excerpt(s): This invention is in the field of devices implanted within a human body for the purpose of automatically detecting the onset of myocardial infarction, warning the patient that a myocardial infarction is occurring and promptly releasing medication into the bloodstream for the purpose of dissolving obstructive thrombus in a coronary artery thus ameliorating damage to the myocardial tissue which would otherwise occur. The invention also includes the capability for treating ischemic stroke. Heart disease is the leading cause of death in the United States. The most prevalent fatal manifestation of coronary heart disease is myocardial infarction which is caused primarily by a thrombus that obstructs blood flow in one or more coronary arteries. The medical treatment of myocardial infarction involves intravenous delivery of a thrombolytic medication such as tissue plasminogen activator (tPA) to help dissolve the thrombus in a coronary artery. The sooner thrombolytic medication is placed into the patient's bloodstream after the occurrence of a myocardial infarction, the sooner an obstructive thrombus will be

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dissolved and some perfusion of the myocardium can occur. The extent of permanent damage to the myocardium is highly dependent upon the length of time that occurs prior to restoration of blood flow to the heart muscle. However, at this time no implantable system exists that provides for early and automatic detection of myocardial infarction. Furthermore, no system exists that would provide automatic and immediate release of an anti-thrombogenic or thombolytic agent into the bloodstream to dissolve an obstructive blood clot at the earliest possible time and prevent the recurrence of a blood clot. One of the most debilitating diseases to which human beings are subjected is thrombotic stroke that is caused by a blood clot blocking a cerebral artery. There are approximately 500,000 such strokes in the USA each year with a 30 day survival rate of less than 80%. The lifetime cost for treatment of each of these patients exceeds $90,000. Therefore, any treatment modality that could decrease brain damage from thrombotic stroke would be highly advantageous to the population of the USA and the rest of the world both from a health point of view and from a cost saving prospective. Web site: http://www.delphion.com/details?pn=US06468263__ •

Interactive method of performing cardipulmonary resuscitation with minimal delay to defibrillation shocks Inventor(s): Morgan; Carlton (Bainbridge Island, WA), Snyder; David (Bainbridge Island, WA) Assignee(s): Koninklijke Philips Electronics N.v. (eindhoven, Nl) Patent Number: 6,553,257 Date filed: March 13, 2001 Abstract: A method for reducing delay between termination of cardiopulmonary resuscitation and administration of a defibrillating shock. An electrocardiogram signal of the patient is monitored during administration of cardiopulmonary resuscitation to a patient. The electrocardiogram signal is analyzed to determine whether a shockable rhythm exists. It is indicated that a shockable rhythm exists and/or that a defibrillating shock will be administered. Cardiopulmonary resuscitation is stopped. The defibrillating shock is administered within 10 seconds of the cessation of cardiopulmonary resuscitation. Excerpt(s): The present invention relates to external defibrillators. In particular, the present invention relates to a method and device for minimizing delay between the cessation of cardiopulmonary resuscitation and the delivering of a defibrillating shock to a patient. Sudden cardiac death is the leading cause of death in the United States. Most sudden cardiac death is caused by ventricular fibrillation ("VF"), in which the heart's muscle fibers contract without coordination, thereby interrupting normal blood flow to the body. The only known effective treatment for VF is electrical defibrillation, in which an electrical pulse is applied to a patient's heart. The electrical shock clears the heart of the abnormal electrical activity (in a process called "defibrillation") by depolarizing a critical mass of myocardial cells to allow spontaneous organized myocardial depolarization to resume. The electrical pulse must be delivered within a short time after onset of VF in order for the patient to have any reasonable chance of survival. To be effective, the defibrillation shock must be delivered to the patient within minutes of the onset of VF. Studies have shown that defibrillation shocks delivered within one minute after the onset of VF achieve up to a 100% survival rate. However, the survival rate falls to approximately 30% after only 6 minutes. Beyond 12 minutes, the survival rate approaches zero.

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Web site: http://www.delphion.com/details?pn=US06553257__ •

Intra-aortic balloon pump having improved automated electrocardiogram based intraaortic balloon deflation timing Inventor(s): Nigroni; Paul (29 Borman Dr., Wanaque, NJ 07465), Sarraf; Lara (54 Waldwick Ave., Waldwick, NJ 07463) Assignee(s): None Reported Patent Number: 6,679,829 Date filed: May 7, 2001 Abstract: An intra-aortic balloon pump (IABP) having improved automated electrocardiogram (ECG) based intra-aortic balloon deflation timing. Said IABP capable of automatically determining to either deflate the intra-aortic balloon upon the detection of the next cardiac cycle (non-predictive deflation) or at an earlier point derived from predicting the occurrence of the next cycle (predictive deflation). This automated determination is based upon a quantitative assessment of the performance of the intraaortic balloon pump in predicting the prevailing cardiac rhythm. Excerpt(s): The invention relates to an intra-aortic balloon pump having improved automated electrocardiogram (ECG) based intra-aortic balloon deflation timing. More particularly, the invention relates to an intra-aortic balloon pump capable of basing the decision of automatically activating and deactivating non-predictive deflation upon a quantitative assessment of the predictive performance of the intra-aortic balloon pump for the prevailing cardiac rhythm. It is well-known in the art, as described in, for example, the specification of U.S. Pat. No. 4,362,150, to provide cardiac assistance by introducing a balloon into the thoracic aorta of a patient and causing the balloon to inflate and deflate in anti-phase with the contraction of the patient's heart. A balloon of this type is inflated at the beginning of diastole, in order to increase the blood flow to the coronary and carotid arteries. The balloon is then deflated just prior to the start of systole, in order to reduce the load on the left ventricle. It is essential that cardiac activity be sensed reliably to ensure that the balloon is inflated and deflated accurately with respect to the cardiac cycle. Methods of sensing cardiac activity include analysis of aortic pressure and/or analysis of the electrocardiogram. It is known in the art, as described in U.S. Pat. No. 5,169,379, to combine means for effecting such analysis with the aforementioned intra-aortic balloon (IAB) apparatus. Web site: http://www.delphion.com/details?pn=US06679829__

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Ischemia detection during non-standard cardiac excitation patterns Inventor(s): Nelson; Shannon (Minneapolis, MN), Stadler; Robert (Shoreview, MN) Assignee(s): Medtronic, Inc. (minneapolis, Mn) Patent Number: 6,381,493 Date filed: September 28, 1999 Abstract: In using electrogram signals to determine physiologic conditions like ischemia, the bad cardiac cycle information due to noise, axis shifts in the cardiac electrical axis, and the like must be removed if the electrogram signal can be made to be a good indicator. If this is accomplished through the adaptive filtering techniques shown here,

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the signal can be used to drive a closed loop therapy system responsive to those physiologic conditions discernible from good cardiac cycle electrocardiogram signals. Excerpt(s): Reference is hereby made to commonly assigned co-pending U.S. patent applications Ser. No. 09/280,286 filed on even date herewith for IMPROVED METHOD FOR ISCHEMIA DETECTION AND APPARATUS FOR USING SAME in the names of Robert W. Stadler et al., Ser. No. 09/968,454 filed on even date herewith for AXIS SHIFT ANALYSIS OF ELECTROCARDIOGRAM SIGNAL PARAMETERS ESPECIALLY APPLICABLE FOR MULTIVECTOR ANALYSIS BY IMPLANTABLE MEDICAL DEVICES, AND USE OF A SAME in the names Robert W. Stadler et al. Ser. No. 09/280,592 filed on even date herewith for DETERMINATION OF ORIENTATION OF ELECTROCARDIOGRAM SIGNAL IN IMPLANTABLE MEDICAL DEVICES in the names Robert W. Stadler et al. This invention relates to a method and apparatus embodied in an implantable medical device (IMD) or an external medical device (EMD) for monitoring myocardial ischemia of a patient's heart and optionally applying a therapy to a patient experiencing ischemia. Further, this invention relates to ways to detect ischemia through cardiac pacing, and during mixed paced and intrinsic cardiac events, and also during blocked bundle branch intrinsic events. (Blocked bundle branch intrinsic events produce electrocardiogram forms similar to paced events. Accordingly, when in the detailed description reference is made to non-standard or paced electrograms, unless otherwise noted, it should be understood that reference is also being made to bundle branch blocked electrograms). Web site: http://www.delphion.com/details?pn=US06381493__ •

Method and apparatus employing a scaling exponent for selectively defibrillating a patient Inventor(s): Callaway; Clifton W. (Pittsburgh, PA), Sherman; Lawrence D. (Aspinwall, PA) Assignee(s): The University of Pittsburgh (pittsburgh, Pa) Patent Number: 6,438,419 Date filed: September 28, 2000 Abstract: A defibrillator, which selectively delivers a defibrillation pulse to a patient, includes electrodes adapted for placement on the patient, a monitoring circuit for providing an electrocardiogram (ECG) of the patient, and a defibrillation pulse generator having an energy store for delivering a defibrillation pulse. A switch in electrical communication with the ECG monitoring circuit and the defibrillation pulse generator selectively electrically connects the monitoring circuit and the defibrillation pulse generator to the electrodes. A microprocessor is in electrical communication with the monitoring circuit, the defibrillation pulse generator, and the switch. The microprocessor causes the switch to electrically connect the monitoring circuit to the electrodes in order to provide the ECG of the patient. The microprocessor also determines a scaling exponent for the patient from the ECG thereof. The microprocessor further compares the scaling exponent to a predetermined value and selectively causes the switch to electrically connect the defibrillation pulse generator to the electrodes in order that the energy store delivers the defibrillation pulse to the patient. Excerpt(s): The invention is directed to methods and apparatus for delivering defibrillating energy to a patient and, in particular, to methods and apparatus for selectively delivering defibrillating energy to patients. Ventricular fibrillation (VF) is the

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most common initial arrhythmia associated with sudden cardiac death, and is one of the most common life-threatening medical conditions that occurs with respect to the human heart. In ventricular fibrillation, the human heart's electrical activity becomes unsynchronized, which results in a loss of its ability to contract. As a result, a fibrillating heart immediately loses its ability to pump blood into the circulation system. Electrical defibrillation remains the mainstay of therapy for VF. A common treatment for ventricular fibrillation is to apply an electric pulse to the heart that is strong enough to stop the unsynchronized electrical activity and give the heart's natural pacemaker a chance to reinitiate a synchronized rhythm. External defibrillation is the method of applying the electric pulse to the fibrillating heart through a patient's thorax. See, for example, U.S. Pat. No. 5,999,852. Web site: http://www.delphion.com/details?pn=US06438419__ •

Method and apparatus for analyzing heart function using 4D ECG synchronized heart cavity tomoscintigraphy Inventor(s): Bister; Michel (Avenue de la Gazelle 52/54, B-1180 Brussels, BE), Demonceau; Georges (Rodestraat 91, B-9620 Zottegem, BE), Van Hove; Chris (Winkelstraat 5, B-9032 Gent-Wondelgem, BE) Assignee(s): None Reported Patent Number: 6,389,310 Date filed: March 2, 2000 Abstract: A computer program storage medium readable by a computing system and encoding a computer program of instructions for executing a computer process for the treatment of data obtained from synchronized electrocardiogram tomoscintigraphy, said data being correlated to image giving the activity of a heart comprising auricles, ventricles, valves and septum, said image comprising at least: (a) a first portion consisting of the pixels showing the auricles and ventricles during the cardiac cycle, each cycle comprising successive time bins with an end-systole time and end-diastole time, and (b) a second portion consisting of pixels substantially not involved with said cardiac activity. Excerpt(s): The present invention relates to a computer program storage medium suitable for treating data obtained from an synchronized electrocardiogram tomoscintigraphy, as well as a method and an apparatus for executing in a computing system the treatment of said data. Reference is made to various publications for disclosing specific analysis or techniques used in the program and method of the invention. The content of these publications is incorporated in the present specification by reference for the disclosure of specific methods, algorithms, etc. Web site: http://www.delphion.com/details?pn=US06389310__

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Method and apparatus for non-invasively detecting, measuring, and recording electrocardiograms in conscious animals Inventor(s): Hampton; Thomas G. (224 Calumet St., Boston, MA 02120), Otero; Jose M. (500 Memorial Dr., Cambridge, MA 02139) Assignee(s): None Reported Patent Number: 6,445,941 Date filed: March 11, 2000 Abstract: A novel method and apparatus for obtaining the electrocardiogram (ECG) in small conscious animals, such as mice, without the need to anesthetize or instrument the animal, are described. The apparatus includes an array of conductive pads, embedded in a platform, the pads sized and spaced to advance contact between an animal's paws and the pads as the animal freely moves upon the platform. Electrical circuitry to the pads is configured to sense the parings of pads and paws that render an interpretable ECG signal and to activate or deactivate recording of the signals. The apparatus is suspended above a surface to minimize the range of motion of the animal without physical restraint. The method and apparatus of the present invention are intended to replace the use of anesthetics or invasive procedures to obtain ECGs in mice, to limit the range of motion of mice without physical restraint or harnessing, and to advance a common level of animal activity for animal-to-animal comparisons of cardiovascular function. Excerpt(s): U.S. Pat. No. 4,250,888 February 1981 Heartbeat monitoring process and device; Nappholz, et. al. Vetterlein, F, et al. "Method for measurement of heart rate in awake, non-instrumented small animals", American Journal of Physiology 247(16), pp. H1010-H1012, 1984. www.indusinstruments.com; description of ECG monitoring device for mice with built-in ECG electrode contact pads. Web site: http://www.delphion.com/details?pn=US06445941__

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Method and apparatus for using heart sounds to determine the presence of a pulse Inventor(s): Hampton; David R. (Woodinville, WA), Joo; Tae H. (Redmond, WA), Stickney; Ronald E. (Edmonds, WA), Taylor; James W. (Redmond, WA) Assignee(s): Medtronic Physio-control Manufacturing Corp. (redmond, Wa) Patent Number: 6,440,082 Date filed: September 30, 1999 Abstract: A method and apparatus determines the presence of a cardiac pulse in a patient by evaluating a physiological signal in the patient, preferably for the presence of characteristic heart sounds. The presence of a heart sound in a patient is determined by analyzing phonocardiogram (PCG) data obtained from the patient. Analyzing the PCG data may include evaluating temporal energy in the PCG data or evaluating spectral energy in the PCG data. Evaluating temporal energy in the PCG data may include estimating a first and second energy in the PCG data and comparing the first and second energy to determine a relative change in energy between them. Evaluating spectral energy in the PCG data may include calculating an energy spectrum of the PCG data and evaluating either the energy value or the frequency of a peak energy in the energy spectrum. The presence of a heart sound may also be determined by combining an evaluation of temporal energy with an evaluation of spectral energy in the PCG data.

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Electrocardiogram data obtained from the patient may further be used in connection with the PCG data to determine the presence of a cardiac pulse in the patient. An automated external defibrillator processing the physiological signal sensed in the patient automatically reports to an operator of the defibrillator whether a cardiac pulse is determined to be present. Excerpt(s): The invention relates generally to the detection of cardiac activity in a patient, and more specifically, to the detection of a cardiac pulse. The lack of a detectable cardiac pulse in a patient can be a strong indicator of cardiac arrest. Cardiac arrest is a life-threatening medical condition in which the electrical activity of a patient's heart becomes unsynchronized, resulting in a loss of the heart's ability to contract and pump blood into the circulation system. A caregiver may apply a defibrillation shock to a patient in cardiac arrest to stop the unsynchronized electrical activity and reinitiate a synchronized perfusing rhythm. External defibrillation, in particular, is provided by applying a strong electric pulse to the patient's heart through electrodes placed on the surface of the patient's body. Before providing defibrillation therapy to a patient, a caregiver must first confirm that the patient is in cardiac arrest. A defibrillation shock provided to a patient not in cardiac arrest may itself induce lethal cardiac arrhythmias in the patient. In general, external defibrillation is suitable only for patients that are unconscious, apneic (i.e., not breathing), and pulseless. Medical guidelines indicate that the absence of a pulse in a patient should be determined within 5-10 seconds. Web site: http://www.delphion.com/details?pn=US06440082__ •

Method and device for detecting fault of lead in electrocardiogram system Inventor(s): Kim; In-young (Seoul, KR), Lee; Jong-youn (Seoul, KR), Lee; Sang-min (Seoul, KR) Assignee(s): Samsung Electronics Co., Ltd. (kyungki-do, Kr) Patent Number: 6,421,554 Date filed: December 30, 1999 Abstract: A method and device for detecting a lead fault by analyzing a electrocardiogram signal from a telemetric or portable electrocardiogram system using software. In the device for detecting a lead fault, the electrocardiogram signal can be analyzed using software by a microcontroller without an extra microcontroller, so that the size of a telemetric or portable electrocardiogram system can be reduced while also reducing power consumption. Excerpt(s): The present invention generally relates to a method and device for detecting a lead fault of a telemetric or portable electrocardiogram system and, more particularly, to a method and device for detecting a lead fault of a telemetric or portable electrocardiogram system using software by analyzing the input electrocardiogram signal. An electrocardiogram (ECG or EKG) system collects physiological information by attaching lead markers to the body of a subject and analyze and processing the collected information. An ECG signal collector (referred to as a "lead marker") includes an electrode that directly contacts the skin of the subject and a lead wire for connecting the lead marker to the main body of a measurement apparatus. If a lead marker which is attached to the body of a subject for continuous observation is separated from the body, an alarm is produced so that the lead marker can be reattached. U.S. Pat. No. 3,859,988 discloses a device for detecting a lead fault in a telemetric biomedical system. In this device, a lead marker fault is detected by repeatedly applying a low current signal

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having a specific waveform and frequency to the lead markers. A specific applied signal is output if at least one lead marker is detached, to indicate fault of the lead marker. Accordingly, the lead fault detection device additionally requires a generator for generating a signal having a specific waveform and a counter for repeatedly transmitting the signal. Web site: http://www.delphion.com/details?pn=US06421554__ •

Method for monitoring heart failure Inventor(s): Turcott; Robert (Menlo Park, CA) Assignee(s): Pacesetter, Inc. (sunnyvale, Ca) Patent Number: 6,480,733 Date filed: December 17, 1999 Abstract: A method for monitoring the progression of the hemodynamic status of a heart failure patient. An implantable or other ambulatory monitor senses the patient's electrocardiogram (ECG) and calculates R-R intervals. The R-R intervals are used to calculate a measure of heart rate variability (HRV). Significant excursions from the average of the HRV measure are indicative of a heart failure exacerbation. Alternatively, vascular plethysmography provides a measure of pulse amplitude. Significant reduction in pulse amplitude and pulse amplitude variability are indicative of a heart failure exacerbation. This information may be used to warn the patient or healthcare providers of changes in the patient's condition warranting attention. Excerpt(s): This invention relates generally to implantable monitoring devices, and more particularly to a method for monitoring the hemodynamic status of a patient with a chronic disease such as heart failure, ischemic heart disease, or diabetes. Many chronic diseases, such as diabetes and heart failure, require close medical management to reduce morbidity and mortality. Because the disease status evolves with time, frequent physician follow-up examinations are often necessary. At follow-up, the physician may make adjustments to the drug regimen in order to optimize therapy. This conventional approach of periodic follow-up is unsatisfactory for some diseases, such as heart failure, in which acute, life-threatening exacerbations can develop between physician follow-up examinations. It is well know among clinicians that if a developing exacerbation is recognized early, it can be easily and inexpensively terminated, typically with a modest increase in oral diuretic. However, if it develops beyond the initial phase, an acute heart failure exacerbation becomes difficult to control and terminate. Hospitalization in an intensive care unit is often required. It is during an acute exacerbation of heart failure that many patients succumb to the disease. It is often difficult for patients to subjectively recognize a developing exacerbation, despite the presence of numerous physical signs that would allow a physician to readily detect it. This problem is well illustrated by G. Guyatt in his article entitled "A 75-Year-Old Man with Congestive Heart Failure," 1999, JAMA 281(24)2321-2328. Furthermore, since exacerbations typically develop over hours to days, even frequently scheduled routine follow-up with a physician cannot effectively detect most developing exacerbations. It is therefore desirable to have a system that allows the routine, frequent monitoring of patients so that an exacerbation can be recognized early in its course. With the patient and/or physician thus notified by the monitoring system of the need for medical intervention, a developing exacerbation can easily and inexpensively be terminated early in its course. Web site: http://www.delphion.com/details?pn=US06480733__

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Method of obtaining information that corresponds to electrocardiogram of human body from pulse wave thereof Inventor(s): Kawachi; Taiji (Kariya, JP), Kimura; Teiyuu (Nagoya, JP), Nakagawa; Tsuyoshi (Nagoya, JP), Ohsaki; Rie (Anjo, JP) Assignee(s): Denso Corporation (kariya, Jp) Patent Number: 6,496,723 Date filed: August 28, 2000 Abstract: A method of obtaining information that corresponds to the R--R interval of electrocardiogram from the pulse-wave of a human body. The method is comprised of steps of detecting the pulse-wave of a human body in a predetermined period, differentiating the detected pulse-wave to provide a speed-pulse-wave, measuring intervals of peaks of the speed-pulse-wave, and substituting the intervals of peaks of the speed-pulse-wave for the R--R interval of the electrocardiogram. Excerpt(s): The present application is based on and claims priority from Japanese Patent Applications: Hei 11-242528, filed Aug. 30, 1999 and Hei 11-247264, filed Sep. 1, 1999, the contents of which are incorporated herein by reference. The present invention relates to a method of obtaining information that corresponds to the R--R interval of the electrocardiogram of a human body for medical and health examinations. The electrocardiogram has been used for medical and health examinations. Particularly, the R--R intervals of the electrocardiogram have been frequently used to examine the heart beat rhythm and the automatic nervous system. The R-R intervals of the electrocardiogram are obtained from intervals of peak values of the R-wave that are most significantly observed in the QRS group, which is caused by depolarization of the ventricle. Web site: http://www.delphion.com/details?pn=US06496723__

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Method of quantitative determination of cardiac electrocardiogram-synchronized transverse tomogram

muscle

contraction

by

Inventor(s): Maeda; Hisatoshi (5-7, Kibougaoka 4-chome, Chikusa-ku, Nagoya-shi, Aichi, 464-0016, JP) Assignee(s): None Reported Patent Number: 6,507,752 Date filed: October 10, 2000 Abstract: From ECG-gated SPECT or PET images of radioactive myocardial perfusion imaging agents, contraction of the myocardium along the tangential direction, i.e., in the direction parallel to the myocardium, can be evaluated. The amount of the agents which accumulate in the heart muscle is calculated from reconstructed short-axis ECG-gated images and is projected on a virtual cylindrical screen whose axis is the same as the long axis of the heart. Spatial and temporal changes in time and space in the projected count distribution on the screen are described by a two-dimensional second order differential equation, which is called an equation of continuity for the fluid. This equation can be solved numerically with a computer. The displacements of points on the myocardium in the tangential direction are calculated by projecting the displacement of each point back onto the cardiac wall. From these displacements, contraction and expansion of the heart muscle can be quantified.

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Excerpt(s): This invention relates to a method of evaluating segmental myocardial function from a value of contraction which is calculated from short-axis images of count distribution using radioactive myocardial perfusion imaging agents which accumulate in human heart after intravenous injection, and by using a rotating gamma camera under,electrocardiographic (ECG) gating. Assessment of myocardial function by using radioactive myocardial perfusion imaging agents has been frequently employed. This method includes estimation of myocardial wholesomeness by measuring myocardial blood perfusion and metabolism from the extent of accumulation of these agents. There are two widely employed techniques to evaluate the amount of accumulations: single photon emission computed tomography (SPECT) and positron emission computed tomography (PET). In both techniques, data are acquired from multiple angles around the object and transverse images are obtained. These techniques have advantages of acquiring more information than conventional planar images. Another technique to assess the segmental cardiac function is to analyze ECG-gated images which are obtained by dividing one cardiac cycle into equally divided multiple time intervals. This ECG-gated technique enables us to obtain sequential SPECT or PET images from enddiastolic to end-systolic phases. Web site: http://www.delphion.com/details?pn=US06507752__ •

Method of using spectral measures to distinguish among atrialfibrillation, atrialflutter and other cardiac rhythms Inventor(s): Reddy; Shankara (Cedarburg, WI), Taha; Basel (Menomonee Falls, WI), Xue; Joel (Germantown, WI) Assignee(s): GE Medical Systems Information Technologies, Inc. (milwaukee, Wi) Patent Number: 6,597,943 Date filed: December 26, 2000 Excerpt(s): The field of the invention relates to cardiac monitoring and more particularly to methods of distinguishing between different types of cardiac abnormalities. Atrial fibrillation (AFIB) and atrial flutter (AFL) are two of the most common abnormal cardiac rhythms, constituting up to 8% of electrocardiograms (ECGs) collected by hospitals. The two rhythms have clinically different implications and require different management. In addition, fibrillatory and flutter waves have different generating mechanisms in the atria. However, these two rhythms are often cross classified by physicians and by computerized ECG analysis systems for two main reasons. First, patterns of atrial flutter and fibrillation often coexist within the same ECG segment examined. The second cause of cross-classification is due to the difficulty of detecting atrial activity (visually or by computer time-based analysis) due to the overlying (and dominant) waveforms of ventricular origin (i.e., the QRS complex and T-wave), especially in the case of high ventricular rates. A method and apparatus are provided for differentiating among atrialflutter, atrial-fibrillation and other cardiac rhythms. The method includes the steps of estimating a spectral entropy of atrial cardiac activity from an electrocardiogram of a patient and determining that the patient has atrial fibrillation when the spectral entropy is greater than a predetermined value. Web site: http://www.delphion.com/details?pn=US06597943__

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Methods and devices for combined ECG and PPU controlled magnetic resonance imaging Inventor(s): Botnar; Rene M. (Brookline, MA), Manning; Warren J. (Boston, MA), Stuber; Matthias (Brookline, MA) Assignee(s): Koninklijke Philips Electronics N.v. (eindhoven, Nl) Patent Number: 6,501,979 Date filed: March 9, 2000 Abstract: This invention relates to methods and apparatus for medical imaging of parts of a patient in which imaging data acquisition is gated by a combination of electrocardiogram (ECG) and peripheral pulse (PPU) signals from the patient. The methods of the invention include obtaining ECG signals from a patient in a medical imaging apparatus, obtaining PPU signals from the patient, providing one or more synchronization signals in dependence on both the ECG signals and the PPU signals, wherein the synchronization signals indicate occurrences of pre-determined phases of the cyclic movements of the heart only if the PPU signals also indicate that the determined heart phase is physiologically possible, and controlling the medical imaging apparatus in dependence on the synchronization signals to collect imaging data synchronized with cyclic movements of the heart from the patient in the examination zone and to reconstruct a medical image of a part of the patient from the collected imaging data. The medical imaging apparatus of the invention includes such units in addition to the imaging units as are necessary from the practice of the methods of the invention. This invention is preferably applied to magnetic resonance imaging and to computed tomographic x-ray imaging. Excerpt(s): The present invention relates to methods and systems for medical imaging of parts of a patient in which acquisition of data by a medical imaging apparatus for image reconstruction is gated by a combination of electrocardiogram (ECG) and peripheral pulse (PPU) signals from the patient. Many organs and regions of the body of a patient are affected by cardiac and respiratory motions, including, for example, not only the heart, the lungs, and vessels throughout the body, but also abdominal organs, especially upper abdominal organs, and intracranial structures. For the medical imaging of such affected organs, it is often useful, or even necessary, to take these motions into account. On the one hand, in the case of those imaging modalities, such as a conventional x-ray imaging, in which a single image is acquired in a short exposure (for example, a few milliseconds (msec) or less), it is often useful for images to be acquired at known and pre-determined phases of cardiac or respiratory motions. However, on the other hand, in the case of those imaging modalities which reconstruct a recognizable image from imaging data acquired over a period of time (for example, 100 msec. or more), it is often necessary to take body motion into account in order to avoid motion artifacts that degrade reconstructed images and render them less useful clinically. Currently, important modalities of this nature include magnetic resonance (MR) imaging, computer tomographic (CT) x-ray imaging, and nuclear imaging of particles emitted by radioactive tracers administered to a patient. For many cardiac, vascular, neurologic, and other imaging examinations using such modalities, synchronization of imaging data collection sequences to the intrinsic motion of the heart is crucial to obtain high-quality images without motion artifacts. Web site: http://www.delphion.com/details?pn=US06501979__

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Non-invasive blood glucose measurement techniques Inventor(s): Chou; Mau-Song (Rancho Palos Verdes, CA) Assignee(s): Trw Inc. (redondo Beach, Ca) Patent Number: 6,477,393 Date filed: July 19, 2000 Abstract: Non-invasive measurement of blood glucose is achieved by transmitting a ring of electromagnetic radiation to the surface of a subject (S) by a ring illuminator (22). The radiation diffuses into the subject illuminated and emits a portion of the radiation in area (E2) displaced from the illuminated area. A CCD camera (40) collects at least a portion of the emitted radiation and generates detection signals which are processed by a processor (100) in order to measure blood glucose concentration. The processing may be synchronized with the heart beat of the subject by an electrocardiogram (74). Excerpt(s): This invention relates to non-invasive measurement of glucose in a biological matrix and more particularly relates to such measurements employing visible or near infrared radiation. Many diabetic patients rely on self-monitoring of blood glucose for the proper regulation of an insulin therapy. Diabetic patients would benefit from a device capable of providing continuous non-invasive monitoring of their blood glucose levels. In addition to eliminating pain or possible infection, such monitoring can provide complete information on the blood glucose changes occurring over a long period of time. This information would enable the patient to optimize insulin doses and improve metabolic control. Current progress on development of non-invasive glucose monitors has been recently reviewed in an article entitled "Spectroscopic and Clinical Aspects of Noninvasive Glucose Measurements," by O. S. Khalil, published in volume 45 of Clinical Chemistry, P. 165 (1999). According to Khalil, several research groups are trying to develop non-invasive glucose monitoring systems based on absorption measurements in the near infrared region, although none has been converted into a reliable glucose monitoring system. One of the main problems preventing such development is that the expected glucose absorption is very low as compared to other components in the tissue, such as water. Web site: http://www.delphion.com/details?pn=US06477393__

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Palm sized medical examination device Inventor(s): Ayanruoh; Steve T (115 Eisenhower Dr., Yonkers, NY 10710) Assignee(s): None Reported Patent Number: 6,381,484 Date filed: July 12, 1999 Abstract: A hand held medical examination device for performing a physical examination on a patient. The hand held medical examination device includes a hand held computer including a microprocessor, a touch screen for inputting data to the microprocessor, a display screen and a connection port. A cable wire is connected to the microprocessor through the connection port and includes a universal adapter for connection to any one of a plurality of medical devices used to perform a physical examination. A camera extends through the cable wire for capturing an image viewed through the medical device connected to the universal adapter and provides data related to the captured image to the microprocessor for processing and display on the

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display screen. A memory unit is connected to the microprocessor for storing data input from the keyboard and camera related to a plurality of patients. The touch screen displays prompts for inputting data to the microprocessor in accordance with a software program stored in memory. The hand held medical examination device may also be provided along with a peripheral device port for connecting the microprocessor to a peripheral device. The plurality of medical devices which may be connected to the universal adapter include an ear piece, a pair of eye glasses, a tongue depressor and electrocardiogram probes. Excerpt(s): The present invention relates generally to medical devices and, more specifically, to a palm sized device able to store data regarding a patient and connect with various medical devices for displaying images viewed through the medical devices on a display screen thereby aiding a medical technician in performing an examination. Numerous types of devices for aiding in the performing a medical examination have been provided in the prior art. For example, U.S. Pat. Nos. 4,756,304; 5,437,626; 5,468,947; 5,739,665 and 5,778,882 all are illustrative of such prior art. While these units may be suitable for (lie particular purpose to which they address, they would not be as suitable for the purposes of the present invention as heretofore described. An arthroscopic video camera system especially constructed to utilize a compact miniature CCD chip type of color video camera for high resolution and high light sensitivity. A disposable sterile plastic housing is provided for the camera. Prior to the arthroscopic procedure, the camera is placed in the sterile plastic housing, and is connected through a sterile electric cord to an electronic control unit. A gas sterilized adapter is plugged into an arthroscopic mounting bracket, and a sterilized light cord extending from a remote light source is then plugged into the mounting bracket. Finally, a selected arthroscope is also plugged into the mounting bracket by light from the remote source, and to provide images through the mounting bracket for the video camera. Web site: http://www.delphion.com/details?pn=US06381484__ •

Portable electrocardiogram monitor Inventor(s): Itoh; Teruaki (5-25, Kokaihommachi, Kumamoto-shi, Kumamoto-ken, JP) Assignee(s): None Reported Patent Number: 6,587,712 Date filed: May 26, 2000 Abstract: A portable electrocardiogram monitor according to the present invention includes an electrode piece fixed in contact with the surface of a body of a user, for receiving an electrical signal corresponding to a bioelectric current generated by contraction of heart muscles, a signal amplifier for amplifying the electrical signal, a processor for processing the amplified signal to acquire electrocardiogram waveform data, a display for displaying an electrocardiogram based on the electrocardiogram waveform data, a memory for storing electrocardiogram waveform data of the user who is in good health, as standard data, a comparator for comparing the electrocardiogram waveform data with the standard data, a determination unit for determining one of presence and absence of abnormality according to whether a difference between the electrocardiogram waveform data and the standard data exceeds a permissible range, and an alarm generator for raising an alarm when the determination unit determines the presence of abnormality.

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Excerpt(s): This application is based upon and claims the benefit of priority from the prior Japanese Patent Applications No. 11-152472, filed May 31, 1999; and No. 2000134704, filed May 8, 2000, the entire contents of which are incorporated herein by reference. The present invention relates to a portable electrocardiogram monitor which can easily be carried with a user having a heart disease as a chronic one while he or she is traveling or the like. Various types of portable medical equipment have recently been developed in accordance with a transition to an aging society; however, no portable electrocardiogram monitors have been done yet. Electrocardiograms are tracing made by inducing bioelectric currents generated by the contraction of heart muscles. It is thus difficult for an amateur having no expert knowledge to find heart abnormalities at a glance at the electrocardiogram. Web site: http://www.delphion.com/details?pn=US06587712__ •

Prion gene modified mouse which exhibits heart anomalies Inventor(s): Itohara; Shigeyoshi (Saitama, JP), Onodera; Takashi (Ibaraki, JP), Tsubone; Hirokazu (Ibaraki, JP) Assignee(s): Riken (jp) Patent Number: 6,657,105 Date filed: January 25, 2001 Abstract: The present invention relates to a method for detecting an aberrant animalderived prion gene wherein the method comprises steps of introducing a prion gene of an animal into a mouse to produce a prion gene modified mouse and determining that the prion gene is aberrant when the prion gene modified mouse exhibits heart anomalies; a prion gene modified mouse which exhibits heart anomalies; and a method for detecting drugs which reduce abnormal waves in an electrocardiogram of the mouse. Excerpt(s): The present invention relates to a method for detecting an aberrant animalderived prion gene. The invention further relates to a prion gene modified mouse which exhibits heart anomalies, and to a method for detecting drugs which reduce anomalies in an electrocardiogram of said mouse. Transmissible spongiform encephalopathy is a neurodegenerative disease observed in many kinds of mammal. These diseases are prion diseases caused by anomalies in prion proteins (PrP). Among these, kuru, Creutzfeldt-Jacob disease (CJD), Gerstmann-Straussler-Scheinker desease (GSS) in humans; and scrapie and bovine spongiform encephalopathy in ruminant livestocks such as sheep and cattle are known, and are a serious problems even today. A cause of the epidemic of prion diseases such as BSE in animals is thought to be livestock feed from sheep infected with scrapie, however, the causal link between the feed and incidence has not been confirmed. The British medical journal "Lancet" issued on Apr. 6, 1996 reported 10 cases of human transmissible spongiform encephalopathy, a new type of Creutzfeldt-Jacob disease (CJD) in the United Kingdom. This disease has been on the increase having killed 48 persons in the United Kingdom and 2 persons in France; and CJD has been under surveillance all over the world including Japan. The World Health Organization (WHO) has promoted research and development using transgenic animals. They are considered to be useful for detecting diseases sensitively in early stages and developing removal methods of pathogens. Owing to this research, the causal link between mad cow disease and CJD is gradually being elucidated. Web site: http://www.delphion.com/details?pn=US06657105__

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•

Rate management during automatic capture verification Inventor(s): Gryzwa; Mark (Woodbury, MN), Zhu; Qingsheng (Little Canada, MN) Assignee(s): Cardiac Pacemakers, Inc. (st. Paul, Mn) Patent Number: 6,473,649 Date filed: December 22, 1999 Abstract: An implantable cardiac rhythm management device capable of automatically detecting intrinsic and evoked response of a patient's heart and suitable for use during capture verification. The device of the present invention may operate in an automatic capture verification mode, wherein an electrocardiogram signal of a patient's heart is received and used by the device to determine whether a stimulation pulse evokes a response by the patient's heart. The device suspends the automatic capture verification mode and/or adjust the detection threshold dependent upon detected and/or measured noise, a determined amplitude of evoked response, a determined modulation in the evoked response, or detected and/or measured artifact. Further, the sensing circuit of the rhythm management device of the present invention reduces afterpotentials that result due to delivery of the stimulation pulses. Excerpt(s): This invention relates generally to a device for stimulating cardiac tissue, and more particularly relates to an implantable cardiac rhythm management device capable of automatically detecting intrinsic and evoked response of a patient's heart. The device of the present invention may operate in an automatic capture verification mode, wherein an electrocardiogram signal of a patient's heart is received and used by the device to determine whether a stimulation pulse evokes a response by the patient's heart. The rhythm management device may automatically adjust the detection threshold during a normal mode or an automatic capture verification mode. Also, the device may suspend the automatic capture verification mode and/or adjust the detection threshold dependent upon detected and/or measured noise, a determined amplitude of evoked response, a determined modulation in the evoked response, or detected and/or measured artifact. Further, the sensing circuit of the rhythm management device of the present invention reduces afterpotentials that result due to delivery of the stimulation pulses. Cardiac rhythm management devices have enjoyed widespread use and popularity over the years as a means for supplanting some or all of an abnormal heart's natural pacing functions. The various heart abnormalities remedied by these stimulation devices include total or partial heart block, arrhythmias, myocardial infarctions, congestive heart failure, congenital heart disorders, and various other rhythm disturbances within the heart. The cardiac rhythm management devices generally include a pulse generator for generating stimulation pulses to the heart electrically coupled to an electrode lead arrangement (unipolar or bipolar) positioned adjacent or within a pre-selected heart chamber for delivering pacing stimulation pulses. Regardless of the type of cardiac rhythm management device that is employed to restore the heart's natural rhythm, all operate to stimulate excitable heart tissue cells adjacent to the electrode of the lead. Myocardial response to stimulation or "capture" is a function of the positive and negative charges found in each myocardial cell within the heart. More specifically, the selective permeability of each myocardial cell works to retain potassium and exclude sodium such that, when the cell is at rest, the concentration of sodium ions outside of the cell membrane is significantly greater than the concentration of sodium ions inside the cell membrane, while the concentration of potassium ions outside the cell membrane is significantly less than the concentration of potassium ions inside the cell membrane.

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Web site: http://www.delphion.com/details?pn=US06473649__ •

RF ablation apparatus and method having electrode/tissue contact assessment scheme and electrocardiogram filtering Inventor(s): Anderson; Russ E. (Marine on St. Croix, MN), Bowe; Wade A. (Temecula, CA), Castellano; Thomas M. (Temecula, CA), Lockwood; Kathryn E. (San Diego, CA), Sherman; Marshall L. (Cardiff, CA), Simpson; John A. (Carlsbad, CA), Sun; Weimin (Plymouth, MN) Assignee(s): Cardiac Pacemakers, Inc. (st. Paul, Mn) Patent Number: 6,391,024 Date filed: June 17, 1999 Abstract: A method of assessing the adequacy of contact between an ablation electrode and biological tissue within a biological organ having biological fluid therein includes the steps of positioning the ablation electrode proximal the biological tissue; positioning a reference electrode a distance from the ablation electrode; measuring the impedance between the ablation electrode and the reference electrode at a first frequency and measuring the impedance between the ablation electrode and the reference electrode at a second frequency. The percentage difference between the first-frequency impedance and the second-frequency impedance provides an indication of the state of electrode/tissue contact. In general, a percentage difference of at least approximately 10% serves as an indication of substantially complete electrode/tissue contact. A percentage difference in the approximate range between 5% and 10% serves as an indication of partial electrode/tissue contact. A percentage difference less than approximately 5% serves as an indication of no electrode/tissue contact. Ratiometric measurements may also be used to assess the state of electrode/tissue contact. Excerpt(s): The invention relates generally to an electrophysiological ("EP") apparatus and method for providing energy to biological tissue, and more particularly, to an EP apparatus and method for assessing the adequacy of contact between an ablation electrode and biological tissue. The invention also relates to an apparatus and method for providing energy to biological tissue while simultaneously monitoring the electrical activity within the tissue. While there are different treatments for cardiac arrhythmia, including the application of anti-arrhythmia drugs, in many cases ablation of the damaged tissue can restore the correct operation of the heart. Such ablation can be performed by percutaneous ablation, a procedure in which a catheter is percutaneously introduced into the patient and directed through an artery to the atrium or ventricle of the heart to perform single or multiple diagnostic, therapeutic, and/or surgical procedures. In such case, an ablation procedure is used to destroy the tissue causing the arrhythmia in an attempt to remove the electrical signal irregularities or create a conductive tissue block to restore normal heart beat or at least an improved heart beat. Successful ablation of the conductive tissue at the arrhythmia initiation site usually terminates the arrhythmia or at least moderates the heart rhythm to acceptable levels. A widely accepted treatment for arrhythmia involves the application of RF energy to the conductive tissue. In the case of atrial fibrillation ("AF"), a procedure published by Cox et al. and known as the "Maze procedure" involves continuous atrial incisions to prevent atrial reentry and to allow sinus impulses to activate the entire myocardium. While this procedure has been found to be successful, it involves an intensely invasive approach. It is more desirable to accomplish the same result as the Maze procedure by use of a less invasive approach, such as through the use of an appropriate EP catheter system

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providing RF ablation therapy. In this therapy, transmural ablation lesions are formed in the atria to prevent atrial reentry and to allow sinus impulses to activate the entire myocardium. Web site: http://www.delphion.com/details?pn=US06391024__ •

System and method for complexity analysis-based cardiac tachyarrhythmia detection Inventor(s): Lin; Dongping (Irvine, CA), Zhang; Xu-Sheng (Santa Ana Heights, CA) Assignee(s): Cardiac Science Inc. (irvine, Ca) Patent Number: 6,490,478 Date filed: September 25, 2000 Abstract: A system and method based on electrocardiogram (ECG) complexity analysis for real-time detecting shockable ventricular fibrillation (VF) and ventricular tachycardia (VT), and discriminating them from non-shockable tachyarrhythmia (e.g. supraventricular tachycardia (SVT) and atrial fibrillation (AF)) and high-frequency noise. In the disclosed invention, complexity measure CM (0 to 100), quantitatively characterizing the complexity nature of the non-linear dynamics underlying cardiac arrhythmia, is extracted from the sensed patient ECG signal using ECG complexity analysis. From the calculated complexity measure, by three thresholds (low complexity threshold (LCT), mediate complexity threshold (MCT), and high complexity threshold (HCT)), different kinds of tachyarrhythmia (i.e. heart rate (HR) above a preset rate threshold) and high-frequency noise are discriminated from each other: for nonshockable tachyarrhythmia, CM.ltoreq.LCT; for VT, LCT
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the safety of a device, as well as its ease of use, extent of automatic operation, and widespread acceptance also depend on the performance of the arrhythmia detection system and method. Web site: http://www.delphion.com/details?pn=US06490478__ •

System for the detection of cardiac events Inventor(s): Fischell; David R. (Fair Haven, NJ), Fischell; Robert E. (Dayton, MD), Fischell; Tim A. (Kalamazoo, MI), Harwood; Jonathan (Rumson, NJ) Assignee(s): Angel Medical Systems, Inc. (fair Haven, Nj) Patent Number: 6,609,023 Date filed: September 20, 2002 Abstract: Heart disease is the leading cause of death in the United States. A heart attack (also known as an Acute Myocardial Infarction (AMI)) typically results from a thrombus that obstructs blood flow in one or more coronary arteries. The extent of damage to the myocardium from an AMI is strongly dependent upon the length of time prior to restoration of blood flow to the heart muscle. Acute myocardial infarction and ischemia may be detected from a patient's electrocardiogram (ECG) by noting an ST segment shift (i.e., voltage change) over a relatively short (less than 5 minutes) period of time. The present invention is a guardian system including electrodes, a cardiosaver device having AMI detection capability and an alarm means to warn the patient that they have had an AMI or other serious cardiac event and should immediately seek medical attention. Such a warning would facilitate getting medical treatment quickly to restore blood flow to the patient's heart muscle. The present invention provides accuracy of detection by comparing a recently collected electrogram data with baseline electrogram data collected at an earlier time when the heart signals were normal. False positives are reduced by requiring multiple detections separated by a predetermined time interval. The present invention can identify and differentiate between an acute myocardial infarction, exercise induced ischemia and other anomalous cardiac conditions. In the preferred embodiment of the present invention the electrodes and the cardiosaver are implanted and the guardian system includes an external alarm system that can produce an external alarm signal and also has means to turn off the alarm. Excerpt(s): Heart disease is the leading cause of death in the United States. A heart attack (also known as an Acute Myocardial Infarction (AMI)) typically results from a thrombus that obstructs blood flow in one or more coronary arteries. AMI is a common and life-threatening complication of coronary heart disease. The sooner that perfusion of the myocardium is restored (e.g., with injection of a thrombolytic medication such as tissue plasminogen activator (tPA)), the better the prognosis and survival of the patient from the heart attack. The extent of damage to the myocardium is strongly dependent upon the length of time prior to restoration of blood flow to the heart muscle. Myocardial ischemia is caused by a temporary imbalance of blood (oxygen) supply and demand in the heart muscle. It is typically provoked by physical activity or other causes of increased heart rate when one or more of the coronary arteries are obstructed by atherosclerosis. Patients will often (but not always) experience chest discomfort (angina) when the heart muscle is experiencing ischemia. Acute myocardial infarction and ischemia may be detected from a patient's electrocardiogram (ECG) by noting an ST segment shift (i.e., voltage change) over a relatively short (less than 5 minutes) period of time. However, without knowing the patient's normal ECG pattern detection from standard 12 lead ECG can be unreliable. In addition, ideal placement of subcutaneous

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electrodes for detection of ST segment shifts as they would relate to a subcutaneously implanted device has not been explored in the prior art. Web site: http://www.delphion.com/details?pn=US06609023__

Patent Applications on Electrocardiogram As of December 2000, U.S. patent applications are open to public viewing.9 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to electrocardiogram: •

Apparatus and method for reading and analyzing ECG images Inventor(s): Badilini, Fabio F.; (Montichiari, BS) Correspondence: Thomas R. Fitzgerald, ESQ.; Jaeckle Fleischmann & Mugel, Llp; 39 State Street; Rochester; NY; 14614-1310; US Patent Application Number: 20020172404 Date filed: May 17, 2001 Abstract: A method of analyzing an electrocardiogram (ECG) paper chart includes the steps of scanning the ECG chart, to thereby create a computer-readable ECG image file representative of the ECG chart, storing the ECG image file in a memory of a computer, opening the ECG image file and displaying on a computer display an ECG plot corresponding to the ECG image file, calibrating the x-axis and y-axis of the displayed ECG plot with an x-axis scale and a y-axis scale, identifying characteristics of the ECG plot by using an input device connected to the computer, and measuring the identified characteristics. Excerpt(s): The present invention relates generally to cardiology, and, more particularly, to an apparatus and method for reading and analyzing electrocardiographic charts, especially electrocardiographic charts recorded on paper. Electrocardiograph (EKG) machines are used as a diagnostic tool in medicine, and measure electrical activity in the heart muscle. After each contraction of the heart, an electrical impulse is generated in the sinoatrial node (SA Node) of the heart. The EKG machine traces the path of the impulse as it spreads though the heart, and produces a graph or trace of the electrical impulses often referred to as an electrocardiogram (ECG). There is a growing need to identify changes that occur in ECGs that are associated with, for example, pharmacological interventions, genotypes and different pathophysiological substrates. For example, one specific need is to determine whether a given compound significantly modulates the repolarization duration process of cardiac beats. Generally, EKG machines include or are associated with a printing means that produces on paper an ECG chart. Reading and analyzing the paper ECG chart typically requires the use of a ruler or a system of calipers in order to measure and determine certain characteristics of the ECG, such as, for example, time intervals and peak magnitudes. One example of such a caliper system for use in measuring paper ECG charts is described in U.S. Pat. No. 4,388,759, which is herein incorporated by reference. The caliper system described therein is used to determine deflection amplitudes, intervals and frequencies from standard ECG tracings or charts, and consists of two calibrated caliper arms coupled

9

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

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together for rotation about a pivot pin to determine distances between different caliper points. A second example of a caliper system for use in measuring paper ECG charts is described in U.S. Pat. No. 4,936,022, which is also herein incorporated by reference. The caliper system described therein includes a multi-leg caliper device having a plurality of parallel members and pivot points, and is used to measure characteristics of a conventional paper chart ECG by placing several indicia over a suitably calibrated scale and comparing the values on the indicia chart adjacent indicating portions of the multileg caliper. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Apparatus and method for recording an electrocardiogram using non-obtrusive sensors Inventor(s): Schulze, Arthur E.; (Wharton, TX), Tuttle, Waneta C.; (Albuquerque, NM) Correspondence: Roberts Abokhair & Mardula; Suite 1000; 11800 Sunrise Valley Drive; Reston; VA; 20191; US Patent Application Number: 20030045787 Date filed: September 5, 2002 Abstract: The present invention is to a method and apparatus to allow a portable patient data monitor to obtain an electrocardiogram (ECG) for transmission, such as over the Internet. A small electrical conductive patch is added to a sensor which is currently placed in the ear. This patch is used as a "dry" electrode to sense one side of the electrocardiogram signal generated within the subject. A second electrical conductive patch is added to the enclosure of the patient data monitor or other instrumentation package attached or located in an area near the waist of the patient. Wires or wireless interconnections are used to connect these two patches to an electrocardiogram amplifier. Excerpt(s): This application claims priority to U.S. Provisional Application Ser. No. 60/371,341, filed Sep. 5, 2001, hereby incorporated by reference. This invention relates generally to data acquisition and communication devices using sensors in contact with the human body. More particularly, the present invention is a system and method for acquiring, processing, and communicating an electrocardiogram using a multi-variable sensor in the ear of the patient and the case of a data acquisition unit which is used to transmit the data in a wireless mode over the Internet. The present invention is usable with and related to the co-inventor's U.S. Pat. Nos. 5,673,692 and 6,443,890 and portions of the co-pending and commonly owned U.S. patent application Ser. Nos. 09/783,913 and 09/860,950, hereby incorporated by reference, as applied to generalized acquisition and transfer of data to central Internet databases. The invention allows the transduction of a clinically relevant lead of the electrocardiogram using the location of the multivariable, single-site sensor that was described in U.S. Pat. No. 5,673,692 combined with the modified case the Patient data monitor which has previously been described U.S. Pat. No. 6,443,890 and in the above-mentioned U.S. Patent Applications. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Apparatus for detecting sleep apnea using electrocardiogram signals Inventor(s): Chazal, Phillip de; (Sutton, AU), Heneghan, Conor; (Dublin, IE), sheridan, Elaine; (Crossdoney, IE) Correspondence: Patrick R. Scanlon; Pierce Atwood; One Monument Square; Portland; ME; 04101; US Patent Application Number: 20030055348 Date filed: September 14, 2001 Abstract: There is provided a method of determining a diagnostic measure of sleep apnea including the following steps: acquiring an electrocardiogram signal, calculating a set of RR intervals and electrocardiogram-derived respiratory signal from said electrocardiogram, and hence calculating a set of spectral and time-domain measurements over time periods including power spectral density, mean, and standard deviation. These measurements are processed by a classifier model which has been trained on a pre-existing data base of electrocardiogram signals to provide a probability of a specific time period containing apneic episodes or otherwise. These probabilities can be combined to form an overall diagnostic measure. The system also provides a system and apparatus for providing a diagnostic measure of sleep apnea. Excerpt(s): This invention relates to cardio-respiratory monitoring and analysis, and more particularly to methods for diagnosing sleep disorders. More specifically, the present invention is aimed at detection of sleep apnea using the electrocardiogram. The invention can be embodied in a form suitable for use in a dedicated medical setting, or in the home. Sleep apnea is a significant public health problem. Current estimates are that approximately 4% of the male middle-aged population, and 2% of the female middle-aged population suffer from sleep apnea. Patients suffering from sleep apnea are more prone to hypertension, heart disease, stroke, and irregular heart rhythms. Continued interruption of quality sleep is also associated with depression, irritability, loss of memory, lack of energy, and a higher risk of car and workplace accidents. Current techniques for detection and diagnosis of sleep apnea rely upon hospital-based polysomnography. A polysomnogram simultaneously records multiple physiologic signals from the sleeping patient. A typical polysomnogram includes measurements of blood oxygen saturation level, blood pressure, electroencephalogram, electrocardiogram, electrooculogram, electromyogram, nasal and/or oral airflow chest effort, and abdominal effort. Typically, signals are recorded from a full night's sleep and then a diagnosis is reached following a clinical review of recorded signals. In some patients a second night's recording is required. Because of the number and variety of measurements made, this test can be uncomfortable for the patient and also has a relatively high cost. In general, it is only performed in a dedicated medical facility. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Automated external defibrillator (AED) system Inventor(s): Fincke, Randall; (Concord, MA) Correspondence: Pandiscio & Pandiscio; 470 Totten Pond Road; Waltham; MA; 02154; US Patent Application Number: 20030167075 Date filed: August 30, 2002

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Abstract: An automated external defibrillator (AED) system comprising a defibrillator and its associated electrodes. The defibrillator is compact, rugged, lightweight, inexpensive, easy to use, water-resistant and electronically efficient, wherein the defibrillator is in the form of a unit (or box) with a lid and a body. The body houses the electronics associated with the defibrillator and the lid houses the electrodes. Furthermore, the defibrillator uses a unique hardware design that utilizes a stacked, switched capacitor design to generate bi-phasic waveforms, thereby providing for a compact defibrillator unit. The unit further comprises a liquid crystal display (LCD) that displays pertinent information such as electrocardiogram (ECG) graphs, and a voicebased system that helps guide the user through the defibrillation process. The electrodes of the defibrillator are sealed in a tray that is attached to the interior of the lid. Excerpt(s): (2) pending prior U.S. Provisional Patent Application Serial No. 60/379,467, filed May 10, 2002 by Randall Fincke for AUTOMATED EXTERNAL DEFIBRILLATOR (AED) SYSTEM (Attorney's Docket No. ACCESS-2 PROV). The two foregoing patent applications (including any and all appendices thereto) are hereby incorporated herein by reference. This invention relates to defibrillators in general, and more particularly to automated external defibrillators (AED's). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Cardiac support device and method Inventor(s): Wang, Dai-Yuan; (Bethesda, MD) Correspondence: Law Offices OF Albert Wai-kit Chan; World Plaza; Suite 604; 141-07 20th Avenue; Whitestone; NY; 11357; US Patent Application Number: 20030208098 Date filed: January 15, 2003 Abstract: The invention relates to a cardiopulmonary bypass pump that can be used with medication to put the heart into asystole or near asystolic status. This gives the physician enough time to perform diagnostic and/or therapeutic procedures and also allows the diseased heart to recover from ischemic insults without additional hemodynamic stress, and also facilitates certain cardiac procedures.The patent describes equipment used in conjunction with medication to temporarily replace the function of the heart and to allow the heart to survive with minimal oxygen supply for hours or days, and for the heart to recover from ischemic or other insult or other damage without being subjected to a heavy working load. The invention provides a means to stop blood flow to the heart for a relatively long period of time, thereby allowing the performance of certain procedures that require coronary artery blockade. It also allows the heart to stop contracting, which may result in safer and easier performance of some procedures.A pump is used to drain blood from the patient's veins into a gas exchanger. The exchanger oxygenates the blood and removes carbon dioxide from the blood, then the pump pumps the blood back into the patient. The device maintains blood pressure at a preset level in a pulsatile fashion. A medication is given to the patient while the device is in use in order to stop the heart or slow the heart rate to a minimal level to decrease cardiac oxygen requirements without significant hemostasis in the pulmonary circulation.The systemic circulation can be supported entirely by the pump with the heart in asystole. This allows enough time for certain diagnostic and therapeutic procedures to be performed. The device may also allow the diseased heart to recover from an ischemic insult. The system receives feedback from arterial pressure sensors and utilizes this data to maintain the arterial pressure at a preset level by adjusting the

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pump activity. There is an electrocardiogram (EKG) gating mechanism that coordinates the pump activity with contraction of the heart to avoid active contraction of the heart against the pulsatile pressure head of the device pump. There is an interaction between pressure control and EKG gating to ensure that the arterial pressure is maintained at a preset level and to avoid the heart contracting against the pump. Excerpt(s): The invention disclosed herein claims priority of PCT Application No. PCT/US01/22553, filed Jul. 18, 2001, claiming priority of U.S. Ser. No. 09/618,236, filed on Jul. 18, 2000, the contents of which are incorporated by reference here into this application. Throughout this invention, various references are cited. Disclosures of these publications in their entireties hereby incorporated by reference into this application to describe more fully the state of the art to which this invention pertains. It is well known that if the blood supply to the heart is significantly compromised and the demand of the heart for blood supply remains unchanged or increases (so called supply demand mismatch), the muscle of the heart will be reversibly damaged in a few minutes to a few hours, depending on the severity of the mismatch and other factors. This time limit of the survival of the heart in this condition--only minutes to hours--presents a major challenge to physicians and exposes patients to high mortality and morbidity during myocardial infarction heart attack). Patients may not be able to survive the heart attack or, if they do, they may develop severe heart failure due to extensive injury to the heart. This imposes a huge social and financial burden on society. In most situations, blood supply to the heart can not be improved immediately and, if the demand of the heart for blood supply can be decreased significantly, the heat may survive this insult much longer pending further treatment and may gain enough time to recover from the insult. This is conventionally accomplished in part by keeping the patient at rest, including the use of sedatives if necessary. Also, the patient is typically given supplemental oxygen to make enhanced use of the available cardiovascular function. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Detector for measuring electrocardiogram, pulse and voice sound at the same time Inventor(s): Kuo, Terry B.J.; (Hualien Hsien, TW) Correspondence: J.C. Patents, INC.; Suite 250; 4 Venture; Irvine; CA; 92618; US Patent Application Number: 20030135126 Date filed: January 15, 2002 Abstract: The analyzing system of the present invention, taking electrocardiogram, pulse signals and sound voices from the outside of the body, is readily assessable and complete in function. The analyzing system of the present invention can provide physiological indexes for evaluating the functions of the heart, vocal chord, the respiration system and the autonomic nervous system. The measured signals and obtained data can be on-line analyzed or sent to computer systems for an off-line verification after the completion of the test. Through digital or wireless communications, a rapid on-line diagnosis can be achieved for mitigating potential consequences. Excerpt(s): The present invention relates to a detector system. More particularly, the present invention relates to a detector system for measuring the electrocardiogram, pulse and voice sound at the same time and its analytical system. Almost the function of every organ can be monitored and measured because of the advances in science nowadays. However, most developed techniques are invasive. For example, the cardiovascular checkup needs to put a pipe into the heart through the main artery,

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which is dangerous and painful to the testee (patient). Compared with the invasive techniques, non-invasive techniques are not that painful and distressing to patients. But non-invasive techniques sometimes are not accurate and practical enough, due to its inability of entering into the human bodies. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Device and method for electrocardiography on freely moving animals Inventor(s): Bougher, Joseph A.; (Monticello, IN), Clevenger, Stephen J.; (West Lafayette, IN), Geddes, Leslie A.; (Lafayette, IN), Kissinger, Candice B.; (West Lafayette, IN) Correspondence: Alexander D. Forman; Ice Miller; One American Square; Box 82001; Indianapolis; IN; 46282-0002; US Patent Application Number: 20040006280 Date filed: July 2, 2003 Abstract: The present invention provides an electrocardiography device that is able to obtain the electrocardiogram of a freely moving animal. The present invention utilizes at least two catheters to obtain the electrical signals from the heart of the animal being tested. The catheters are filled with an electrically-conductive, physiological solution and are used in combination with at least two test leads that are able to transfer the electrical signals from the animal to an ECG monitoring device. The present invention also allows for fluids to flow through the catheters to other devices such as a blood sampler controller and/or an infusion pump. Excerpt(s): This application claims the benefit of U.S. Provisional Application No. 60/393,738, filed Jul. 3, 2002. This invention relates to electrocardiography, and, in particular, to a device and method for obtaining electrocardiograms on freely moving animals. An electrocardiograph is essentially a voltmeter or galvanometer which records changing electrical activity in the heart by means of positive and negative electrodes. Electrocardiography is the process of recording the potential differences at these electrodes. An electrocardiogram (hereinafter referred to as an ECG) is a representation on paper, or an oscilloscope display, or a computer screen, of electrical activity in the heart. An ECG is basically obtained by monitoring the voltage changes at electrodes connected to test leads, which leads are, in turn, connected to the electrocardiograph. The electrodes of the test leads can be connected to various regions of the body. In humans, the electrodes are often placed on the chest (precordial chest ECG), while in animals, the electrodes are typically placed on the limbs (body surface limb ECG). Sometimes, electrodes are placed inside the cardiac chambers. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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•

Endoscopic image filing system for recording and managing information on condition of patient in endoscopic examination so as to relate such information with endoscopic image information Inventor(s): Shibata, Hiroyuki; (Yokohama-shi, JP) Correspondence: Scully, Scott, Murphy & Presser; 400 Garden City Plaza; Garden City; NY; 11530; US Patent Application Number: 20040044269 Date filed: August 27, 2002 Abstract: The endoscopic image filing system is principally constituted by an endoscope system for performing an examination by means of endoscopic images; an image filing apparatus, which is connected to the endoscope system and is for recording desired endoscopic images; and a patient monitoring apparatus for monitoring biological information such as the patient's blood pressure and pulse, and an electrocardiogram, which endoscopic image filing system improves the accuracy of an endoscopy diagnosis by recording the condition of the patient in the endoscopic examination along with endoscopic images, referring to the patient's condition while playing back images, and recording the patient's condition in an examination report. Excerpt(s): This application claims benefit of Japanese Application No. 2001-83002 filed in Japan on Mar. 22, 2001, the contents of which are incorporated by this reference. The present invention relates to an endoscopic image filing system for recording endoscopic images, patient information, and the like, and for recording patient biological information measured by means of a patient monitoring apparatus or similar in the course of an endoscopic examination. An endoscope apparatus as used conventionally is constituted such that imaging means are provided in an endoscope which performs observation when a long and narrow insert portion thereof is inserted into an examination site such as a body cavity and constituted such that images of the examination site picked up by the imaging means, that is, endoscopic images, are displayed on a monitor. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Implantable blood flow monitoring system Inventor(s): Franco, Kenneth Lawrence; (Omaha, NE), Mussivand, Tofy V.; (Navan, CA) Correspondence: Gifford, Krass, Groh, Sprinkle; Anderson & Citkowski, PC; 280 N Old Woodard Ave; Suite 400; Birmingham; MI; 48009; US Patent Application Number: 20020198459 Date filed: August 2, 2002 Abstract: An implantable blood flow monitoring system for providing synchronized blood vessel flow and myocardial wall contractility data to an external monitor independent of transcutaneous leads. Synchronized electrocardiogram data allows and provides comprehensive monitoring. A means is provided for transmitting synchronized cardiac function data and blood flow data to a distant remote location to facilitate continual physician monitoring. Excerpt(s): This application is a continuation-in-part of U.S. patent application Ser. No. 09/543,618 filed Apr. 5, 2000. The present invention relates to medical diagnostic equipment and more particularly to an implantable monitoring device capable of

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displaying (a) blood flow and (b) heart wall motion information at a remote location or at a local location with no percutaneous holes or leads. Coronary artery disease (CAD) is a chronic condition requiring continuous management by a physician in order to prevent further cardiac damage and sudden death. Complications typical of coronary artery disease include angina, myocardial infarction, arrhythmia and heart failure due to loss of heart muscle. All of these complications diminish patient quality of life and without proper intervention can lead to death. Coronary artery disease is a major costly and devastating problem projected to be the preeminent health problem worldwide continuously going to year 2020 with in excess of 35 million sufferers. CAD patients that develop angina are initially treated medically with drugs and visit their physician on a regular basis provided the angina remains stable. For those individuals with resting angina, additional testing such as an angiogram and/or other tests are conducted with treatment involving either percutaneous transluminal coronary angioplasty (PTCA)/stent or coronary artery bypass grafting (CABG). Unfortunately, PTCA/stent patients often develop restenosis, requiring further testing and additional repeat procedures to correct recurrent angina. Alternatively, bypass grafts tend to occlude or otherwise develop stenoses over time resulting in recurrent angina, MI, arrhythmia, and heart failure which can lead to death. Myocardial infarctions associated with CAD afflict more than 1 million patients in the U.S. annually with many of which die suddenly therefrom worldwide with this estimate is over 3 million. As a result, CAD patients require regular physician maintenance visits to detect and possibly prevent complications and slow the debilitating effects thereof. Nonetheless, a risk of sudden and premature death from CAD remains as well as loss of heart function. Because very frequent follow up of each patient is impractical, expensive and can plague clinics and hospitals severely, there exists a need to prevent sudden death and the complications of CAD by monitoring of blood flow within coronary arteries. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Interactive method of performing cardipulmonary resuscitaion with minimal delay to defibrillation shocks Inventor(s): Morgan, Carlton; (Bainbridge, WA), Snyder, David; (Bainbridge, WA) Correspondence: Philips Electronics North American; 580 White Plains Road; Tarrytown; NY; 10591; US Patent Application Number: 20020133197 Date filed: March 13, 2001 Abstract: A method for reducing delay between termination of cardiopulmonary resuscitation and administration of a defibrillating shock. An electrocardiogram signal of the patient is monitored during administration of cardiopulmonary resuscitation to a patient. The electrocardiogram signal is analyzed to determine whether a shockable rhythm exists. It is indicated that a shockable rhythm exists and/or that a defibrillating shock will be administered. Cardiopulmonary resuscitation is stopped. The defibrillating shock is administered within 10 seconds of the cessation of cardiopulmonary resuscitation. Excerpt(s): The present invention relates to external defibrillators. In particular, the present invention relates to a method and device for minimizing delay between the cessation of cardiopulmonary resuscitation and the delivering of a defibrillating shock to a patient. Sudden cardiac death is the leading cause of death in the United States. Most sudden cardiac death is caused by ventricular fibrillation ("VF"), in which the

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heart's muscle fibers contract without coordination, thereby interrupting normal blood flow to the body. The only known effective treatment for VF is electrical defibrillation, in which an electrical pulse is applied to a patient's heart. The electrical shock clears the heart of the abnormal electrical activity (in a process called "defibrillation") by depolarizing a critical mass of myocardial cells to allow spontaneous organized myocardial depolarization to resume. The electrical pulse must be delivered within a short time after onset of VF in order for the patient to have any reasonable chance of survival. To be effective, the defibrillation shock must be delivered to the patient within minutes of the onset of VF. Studies have shown that defibrillation shocks delivered within one minute after the onset of VF achieve up to a 100% survival rate. However, the survival rate falls to approximately 30% after only 6 minutes. Beyond 12 minutes, the survival rate approaches zero. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Medical monitoring device and system Inventor(s): Goldberg, Jason; (Thornhill, CA) Correspondence: Brown, Raysman, Millstein, Felder & Steiner Llp; 900 Third Avenue; New York; NY; 10022; US Patent Application Number: 20030073884 Date filed: October 11, 2001 Abstract: A portable device that receives data provided by one or more sensors and displays statistical data related to the sensor data or otherwise related to the person. Statistical data may include high, low, average, mean value, median value, standard deviation, least square, variance, distribution, compilation, etc. for or at any given time or period of time for the person being monitored, as well as for such values for segments or groups of the population, or limit values, or target values, etc. The values may represent measurements and other data related to physiological signs and parameters such as blood pressure, heart rate, body temperature, electrocardiogram, glucose level, substances and/or chemical presence or level, analyze measurements, etc. The portable device may also display such measurements. The portable device may compute the statistical data, with or without the aid of a remote computer, and/or store statistical data, and/or a remote computer may compute and/or store statistical data. The portable device may communicate with a remote computer through a wireless link from the portable device, which may compute and/or store statistical data and measurements. Excerpt(s): The present invention relates generally to a portable medical monitoring device that is sized to be carried by a monitored person, and more particularly, to a portable device that receives data provided by one or more sensors and displays statistical data related to the sensor data. The portable device also provides measurement readings of physiological signs and parameters such as blood pressure. The portable device may operate in a system including a remote computer and a wireless communication link to the portable device. Statistical data may be computed by the portable device, with or without the aid of a remote computer, and/or provided to the portable device partially or entirely by the remote computer. The following United States patents disclose various devices that provide health-related information based upon data obtained by or stored in the devices: U.S. Pat. No. 6,175,752 (Say et al.); U.S. Pat. No. 5,822,715 (Worthington et al.); U.S. Pat. No. 5,840,020 (Heinonen et al.); U.S. Pat. No. 5,576,952 (Stutman et al.); U.S. Pat. No. 6,047,203 (Sackner et al.). The present

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invention provides a portable device that receives data provided by one or more sensors and displays statistical data related to the sensor data or otherwise to the person. Statistical data may include high, low, average, mean value, median value, standard deviation, least square, variance, distribution, compilation, etc. for or at any given time or period of time for the person being monitored, as well as for such values for segments or groups of the population, or limit values, or target values, etc. The values may represent or be related to measurements, and other data for or related to physiological signs and parameters such as blood pressure, heart rate, body temperature, electrocardiogram, glucose level, substances and/or chemical presence or level, analyze measurements, etc. The portable device may also display such measurements and/or sensor data. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Method and apparatus for determining metabolic factors from an electrocardiogram Inventor(s): Gelfenbain, Alexander; (Mountain View, CA), Vasin, Eugene; (Campbell, CA) Correspondence: David G. Beck; Bingham Mccutchen, Llp; Three Embarcadero Center; San Francisco; CA; 94111; US Patent Application Number: 20030171684 Date filed: January 31, 2003 Abstract: Methods and devices are provided for determining metabolic factors using electrocardiogram measurements from a person's Wilson points. A first derivative of an electrocardiogram measurement is calculated. A ratio is calculated of the absolute value of the positive spike of the first derivative to the sum of the absolute values of the positive and negative spikes. In some embodiments, the ratio is multiplied by a constant to determine a metabolic factors. Further operations may be performed on the ratio to determine other metabolic factors. In some embodiments, a garment is provided for easily locating Wilson points. Methods and devices are provided for taking and processing EGC measurements to determine metabolic factors and for using the metabolic factors to optimize an exercise program. Excerpt(s): This invention relates generally to the field of sports medicine. The invention relates more specifically to methods and devices for measuring metabolic factors relating to athletic performance and to designing training programs which account for such measurements. The goal of athletic training is to attain an optimal athletic condition when an athlete is ready to compete without harming the athlete's body. Athletic training includes two major components. The first component involves training the required sports skills or technique. The second component involves training the power, stamina and the rate of muscular reactions. The second component usually includes three types of conditioning, applied at regular intervals: general physical conditioning; endurance training; and special training. General physical conditioning helps prepare an athlete for other types of training. Endurance training increases the metabolic capacity of an athlete. Special training concentrates on muscular activity specific for a chosen type of sport. Athletic training also causes activation of support systems-cardiovascular, respiratory, endocrine, excretory and nervous. It is well known that certain metabolic factors are strongly indicative of an athlete's level of physical conditioning and potential for athletic performance. These metabolic factors are important for determining a person's level of athletic conditioning and for designing an optimal training schedule.

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Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Method and apparatus for diagnosis and diagnostic program Inventor(s): Takizawa, Kiyoshi; (Tokyo, JP) Correspondence: Crowell & Moring Llp; Intellectual Property Group; P.O. Box 14300; Washington; DC; 20044-4300; US Patent Application Number: 20030125632 Date filed: December 19, 2002 Abstract: The present invention makes a diagnosis of a patient by detecting changes in the state of the patient appearing in an electrocardiogram from a variation in characteristic quantities repeatedly appearing in the electrocardiogram, for example, an R-R interval in an early stage and reliably. The ordinary distribution calculation section 3 receives the electrocardiogram data measured for a period INT1, calculates characteristic quantities repeatedly appearing in the electrocardiogram as time-series data and generates a set C of differences between neighboring elements of the timeseries data. The ordinary distribution calculation section 3 further obtains m subsets by repeating m times the processing of randomly collecting n elements from this set C, and calculates an average value.mu. and standard deviation.sigma. of the set of average values of these m subsets by assuming that the set of average values has normal distribution indicating the ordinary state of the variations in the characteristic quantities. The state detection section 4 calculates a diagnostic set CT from the electrocardiogram data for a period shorter than the period INT1 in the same way as for the above-described set C, and the diagnosis section 5 compares the difference between the average value of this set CT and the average value of the ordinary distribution with the standard deviation.sigma. and makes a diagnosis. Excerpt(s): The present invention relates to a method and apparatus for diagnosis and a diagnostic program, and more particularly, to a method and apparatus for diagnosis suitable for diagnosing symptoms of patients through electrocardiogram analysis. Many technologies for diagnosing symptoms of patients by analyzing an electrocardiogram are developed and examples of these technologies include a technology that allows a correct diagnosis by accurately and automatically recognizing characteristic points of individual electrocardiogram waveforms (Japanese Patent Laid-Open No. 8-56914, Japanese Patent Laid-Open No. 9-201344, etc.), a technology that makes a diagnosis by analyzing individual electrocardiogram waveforms (Japanese Patent Laid-Open No. 10225443, U.S. Pat. No. 5,609,158, U.S. Pat. No. 5,560,368, etc.), a technology that extracts time-series data such as R-R interval from an electrocardiogram waveform and makes a diagnosis by analyzing its time series data (U.S. Pat. No. 5,755,671, Japanese Patent LaidOpen No. 6-54815, etc.), etc. Using these technologies allows more efficient and more speedy diagnosis than diagnosis depending only on a visual check of an electrocardiogram and reduces a possibility of overlooking symptoms. The abovedescribed conventional technologies carry out an observation and analysis of an electrocardiogram waveform for a few minutes or over 10 minutes at longest, but it is often the case that data suggesting some abnormality of the heart is not obtained in such a short period. For example, if myocardial infarction occurs, there is a danger of a sudden death in a few hours due to ventricular tachycardia and the probability that arrhythmia will occur in a few days after the occurrence of myocardial infarction reaches 90%. The rate of occurrence of arrhythmia then reduces, but 5 to 10% of patients die within one year. Therefore, it is desirable to acquire and monitor electrocardiogram

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data for many hours continually for diagnoses of such patients. However, according to the prior arts, a doctor reads the record by the naked eye and makes a diagnosis after the recording is finished, or a doctor extracts short-time data that he/she regards as abnormal from the recorded data and subjects the data to an automatic analysis, etc. For this reason, there is a large time delay after measurement until the diagnosis result is obtained, and the prior arts are insufficient in prognosticating changes in a symptom or imminent danger. Furthermore, since the prior arts involve judgments by the naked eye of the doctor, there is a problem that oversight is likely to occur. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Method and apparatus for dynamically selecting an electrocardiogram compression process based on computerized analysis of cardiac rhythm and contour Inventor(s): Elko, Paul P.; (River Hills, WI), Reddy, Shankara B.; (Cedarburg, WI), Taha, Basel H.; (Menomonee Falls, WI), Xue, Joel Q.; (Germantown, WI) Correspondence: Michael Best & Friedrich, Llp; 100 E Wisconsin Avenue; Milwaukee; WI; 53202; US Patent Application Number: 20030083581 Date filed: October 25, 2001 Abstract: A method of automatically selecting a physiological data manipulation process. After raw data including an asynchronous component having diagnostic information and including a synchronous component is received, the asynchronous component is separated from the synchronous component. A data manipulation process based on the diagnostic information is automatically selected based on the signal conditions generated during an analysis process. Excerpt(s): The invention relates to a computerized electrocardiography system and signal processing therefor. More specifically, this invention relates to the compression of electrocardiographic data for permanent storage and for transmission between an ECG acquisition device and an ECG management system or between two ECG devices. The electrocardiogram (ECG) is a very commonly used, simple, non-invasive test to asses a patient's cardiac condition. Each year millions of ECGs (resting, ambulatory, exercise, bedside monitoring, telemetry, etc.) are collected from patients and are stored on ECG management and cardiovascular information systems. Although ECG records are relatively small in size in comparison with diagnostic imaging modalities such as CT and MRI, the large number of ECGs that are collected and managed in large hospitals can place a significant demand on storage space. The large requirement for storage area generates two significant problems. First, the storage device (such as a disk drive) must be large enough to store a large number of ECGs. Second, and more importantly, the communication devices coupling multiple systems are relatively slow, compared to the processing capabilities of the computerized systems. Thus, the time required to transmit a large number of ECGs between computer systems can be significant. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Method and apparatus for generating electrocardiogram precordial leads using a precordial central terminal Inventor(s): Brodnick, Donald E.; (Cedarburg, WI) Correspondence: Michael Best & Friedrich, Llp; 100 E Wisconsin Avenue; Milwaukee; WI; 53202; US Patent Application Number: 20030045804 Date filed: August 31, 2001 Abstract: A method and apparatus for generating a plurality of ECG precordial leads using a precordial central terminal derived from a plurality of electrodes for attachment around the circumference of a patient's upper torso. The apparatus is a device including a plurality of electrodes, an acquisition module including a signal processor coupled to the plurality of electrodes for acquiring electrical signals from the electrodes and for generating a plurality of ECG precordial leads from the acquired electrical signals. According to the method of the invention, an approximation of the electrical potential near the center of the patient's heart (i.e., a precordial central terminal) is generated based on the signals acquired from the plurality of electrodes. The precordial central terminal signal is subtracted from the signal acquired from each electrode attached to the patient's chest in order to generate the precordial leads. Excerpt(s): The invention relates to a method and apparatus for generating a plurality of electrocardiogram (ECG) precordial leads using a precordial central terminal derived from signals from a plurality of electrodes attached to a patient's upper torso. However, in some ECG applications it becomes inconvenient or impossible to place the electrodes on the patient's limbs, because the patient must be free to move. Applications where the patient must be free to move include long term recordings, such as Holter monitoring and event recording; ambulatory patient monitoring, such as telemetry monitoring; and exercise testing on treadmills or bicycles, known as stresstesting. In these tests, the limb electrode positions are unacceptable for electrode placement due to inconvenience, increased danger of tangling of the leadwires, and increased noise from limbs in motion. In light of the limitations described above, a need exists for a method and apparatus for generating precordial leads without attaching electrodes to the patient's limbs. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Method and apparatus for measuring animal's condition by acquiring and analyzing its biological signals Inventor(s): Bang, Seok-won; (Seoul, KR), Kim, Kyung-hwan; (Seongnam-city, KR), Lee, Hyoung-ki; (Suwon-city, KR) Correspondence: Burns Doane Swecker & Mathis L L P; Post Office Box 1404; Alexandria; VA; 22313-1404; US Patent Application Number: 20030166996 Date filed: January 10, 2003 Abstract: A method and apparatus for measuring the biological condition of an animal by acquiring and analyzing its biological signals are provided. The biological signals from skin temperature, a photoplenthysmogram (PPG), an electrocardiogram (ECG), electrodermal activity (EDA), an electromyogram (EMG), and an electrogastrogram (EGG) are detected using a biological signal detection unit which is attached to the

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animal's skin. Feature vectors, including the mean heart rate of the photoplenthysmogram and its standard deviation, the very low frequency, low frequency, and high frequency components of heart rate variability, the frequency and mean amplitude of skin conductance responses, and the mean and maximum skin temperatures, are extracted from the detected biological signals. The biological condition, including needs and emotions, of the animal as to whether or not the animal feels hunger or fear, how much the animal is stressed, or whether or not the animal needs to have a bowel movement, is determined using a pattern classifier which has learned reference vectors, which reflect the behaviors, needs, and emotions of different kinds of animals for various biological conditions and are stored in a predetermined database. Therefore, the biological condition of the animal can be determined through instrumental communication, not through human languages, and the breeding of pets can be efficiently managed. Excerpt(s): This application claims priority from Korean Patent Application No. 20021696, filed Jan. 11, 2002 in the Korean Industrial Property Office, which is incorporated herein in its entirety by reference. The present invention relates to processing a biological signal, and more particularly, to a method and apparatus for measuring an animal's emotional condition and needs by acquiring and analyzing biological signals of an animal, which enable animal-to-human communications. The breeding of pets continues to increase worldwide. Reportedly, about two million pets are bred in South Korea alone, forming a two hundred billion won pet related market. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Method and apparatus for processing physiological data Inventor(s): Voith, Paul Richard; (Milwaukee, WI) Correspondence: Michael Best & Friedrich, Llp; 100 E Wisconsin Avenue; Milwaukee; WI; 53202; US Patent Application Number: 20020188211 Date filed: June 12, 2001 Abstract: A method and apparatus for processing physiological data, particularly nonelectrocardiogram, cardiac-related data, by identifying the physiological data associated with atypical cardiac cycles. Excerpt(s): The invention relates to a method and apparatus for processing physiological data, particularly non-electrocardiogram, cardiac-related data, by identifying the physiological data associated with atypical cardiac events. Much of the physiological data which may be recorded from the human body is related to the cardiac cycle. The most obvious example is the electrocardiogram (ECG). Each time the heart beats, the electrical activity of the heart creates electrical potentials which are detectable with electrodes attached to the body surface. The ECG waveform is so dependent upon the cardiac cycle that it is relied upon to provide significant diagnostic information about the health and functioning of the heart. Moreover, differences in the beat to beat function of the heart closely correlate with beat to beat changes in the morphology of the ECG waveform. In recent years, the manual analysis of the ECG waveform has been enhanced by the use of ECG analysis software algorithms, such as ECG classification engines. ECG classification engines are used to automatically identify and categorize individual heart beats within an ECG waveform stream based on the morphology of the

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individual heart beats. ECG classification engines are also used to form associations among the individual heart beats having similar morphologies. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Method and apparatus for providing patient care Inventor(s): Bui, Tuan; (Green Oaks, IL), Cooper, Thomas G.; (Friendswood, TX), Deckert, Clinton; (Poway, CA), Levitas, Doron; (Chicago, IL), Macha, Emil S.; (Sugar Land, TX), Padda, Shan; (Chicago, IL), Schulze, Arthur E.; (Wharton, TX) Correspondence: Francis C. Kowalik, ESQ.; Corporate Counsel, Law Department; Baxter International INC.; One Baxter Parkway, Df2-2e; Deerfield; IL; 60015; US Patent Application Number: 20020138017 Date filed: November 9, 2001 Abstract: A patient management system includes a programmable patient monitor for monitoring and recording a plurality of physiological conditions of a patient, a plurality of physiological condition sensors and a communications unit. The plurality of patient monitoring sensors are electrically coupled to the programmable patient monitor. Each sensor detects a particular physiological condition of the patient, such as core temperature, ECG electrodes for providing an electrocardiogram and blood oximetry sensors. The patient monitor is small and compact and easily worn by the patient during his normal at home activities. To provide communication with a caregiver via a remote controller at the caregiver's location, a communications unit is disposed in the facility. The communications unit may be selectively coupled to the programmable patient monitor for receiving, storing and transmitting to the remote controller patient physiological condition data and for transmitting instructions from the remote controller to the programmable patient monitor. When the patient connects the patient monitor to the communications unit, the patient can communicate with the caregiver at the remote location. Excerpt(s): This is a divisional application of U.S. patent application Ser. No. 09/219,664 filed Dec. 23, 1998. This invention relates generally to a management system and a method of providing patient care in the home or alternate care setting, i.e., to a system which functions as a virtual hospital room. A hospital room is a place where a patient can receive medical treatment and have his physiological condition monitored under the supervision of a healthcare professional both continuously and at prescribed times. As the cost of health care increases, the trend is to discharge the patient from the hospital earlier, but to continue the therapy at the patient's home or at an alternative care facility. Various medical devices, such as infusion pumps and respirators, allow the patient to receive therapy outside the hospital environment. In many instances the caregiver must visit the patient's home to monitor and control the medical device. Some medical devices, however, include means for enabling the caregiver (or healthcare professional) to monitor and control the medical device's functions from a remote location. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Method and apparatus for real time display of filtered electrocardiogram data Inventor(s): Brodnick, Donald Eugene; (Cedarburg, WI) Correspondence: Cantor Colburn, Llp; 55 Griffin Road South; Bloomfield; CT; 06002 Patent Application Number: 20040024327 Date filed: August 1, 2002 Abstract: A method for displaying waveform data on a display device is disclosed. In an exemplary embodiment, the method includes apportioning a display region into a first portion and a second portion immediately adjacent to the first portion. The first portion is used to display a first segment of the waveform data including the most recently received data extending back to a determined delay period. The second portion is used to display a second segment of the waveform data, the second segment including the remainder of the waveform data. The data displayed in the first portion has a continuously varying amplitude level adjustment applied thereto for partial baseline correction thereof, while the data displayed in the second portion has a corrected baseline amplitude adjustment with no further amplitude level adjustment applied thereto. Excerpt(s): The present disclosure relates generally to methods of real time display of filtered waveform data and, more particularly, to a method and apparatus for real time display of filtered electrocardiogram data. An electrocardiogram (ECG) of a cardiac cycle is detected across sense electrode pairs located on the surface of a patient's body, and is a repetitive waveform characterized by a periodic PQRST electrical activation sequence of the upper and lower heart chambers. The PQRST sequence is associated with the sequential depolarization and contraction of the atria followed by the depolarization and contraction of the ventricles, and successive PQRST complexes are separated by a baseline or isoelectric region. The ST segment of the ECG is typically close in amplitude to the baseline or isoelectric amplitude of the signal sensed between PQRST sequences, depending on the sense electrode pair location. During episodes of myocardial ischemia, the ST segment amplitude is elevated or depressed (depending on positioning of the ECG sense electrodes in relation to the heart) from baseline. These ST segment deviations can be readily recognized by visual examination. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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METHOD AND APPARATUS ELECTROCARDIOGRAMS

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Inventor(s): Reddy, Shankara B.; (Cedarburg, WI), Taha, Basel H.; (Menomonee Falls, WI), Xue, Joel Q.; (Germantown, WI) Correspondence: Michael Best & Friedrich, Llp; 100 E Wisconsin Avenue; Milwaukee; WI; 53202; US Patent Application Number: 20030073914 Date filed: October 11, 2001 Abstract: A method and apparatus for performing serial comparison between electrocardiograms (ECGs) acquired from a patient. The method includes acquiring ECGs from a patient with an acquisition device and using the acquisition device to perform a serial comparison between at least two of the acquired ECGs. The apparatus is an acquisition device including an acquisition module for acquiring ECGs from a

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patient and a signal processor for performing a serial comparison between at least two of the acquired ECGs. Excerpt(s): The invention relates generally to a method and apparatus for the serial comparison of electrocardiograms (ECGs), and more specifically to a method and apparatus for the serial comparison of ECGs using an ECG acquisition device. When a patient is suffering from severe chest pain, clinicians must detect acute coronary syndromes, such as acute myocardial infarction and acute cardiac ischemia, quickly and accurately in order to prevent the death of cardiac muscle and, ultimately, the death of the patient. The ECG is critical for evaluating severe chest pain in a patient in order to detect and manage acute coronary syndromes. When a patient suffering from severe chest pain is admitted into an emergency room, a single, initial ECG is immediately taken and analyzed by an emergency room clinician or by a computerized ECG interpretation program. Similarly, when emergency medical technicians arrive to care for a patient suffering from severe chest pain, a single, initial ECG is immediately taken and analyzed by the emergency medical technicians. Based on the analysis of these single, initial ECGs, acute myocardial infarction is only accurately detected one-half of the time and acute cardiac ischemia is only accurately detected one-third of the time. These poor detection rates are due to the fact that almost two-thirds of all ischemic episodes that occur in patient's suffering from unstable coronary artery disease are silent and cannot be detected by the analysis of a single ECG. Also, fifteen to thirty percent of patients with unstable coronary disease have transient episodes of ST segment changes, predominately ST segment depression, that cannot be detected by the analysis of a single ECG. Similarly, acute coronary syndrome cannot be diagnosed based on a left bundle branch block appearing in a single ECG, because left bundle branch block is only associated with acute coronary syndrome if it is new, i.e., if the left bundle branch block has not occurred in the patient's previous ECGs and then suddenly occurs in a subsequent ECG. However, it is desirable to detect new left bundle branch block, because new left bundle branch block is one of the strongest predictors of mortality in acute coronary syndrome patients. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Method and system for analyzing an electrocardiographic signal Inventor(s): Couderc, Jean-Philippe; (Rochester, NY), Moss, Arthur J.; (Rochester, NY), Zareba, Wojciech; (Rochester, NY) Correspondence: Gunnar G. Leinberg, ESQ.; Nixon Peabody Llp; Clinton Square; P.O. Box 31051; Rochester; NY; 14603-1051; US Patent Application Number: 20030050565 Date filed: August 13, 2002 Abstract: A method for analyzing an ECG signal includes obtaining a measurement of an area based repolarization interval from at least one beat in the electrocardiogram signal and detecting an altered ventricular repolarization based on the obtained measured area based repolarization interval. Excerpt(s): This application claims the benefit of U.S. Provisional Patent Application Serial No. 60/311,921 filed Aug. 13, 2001 which is hereby incorporated by reference in its entirety. The present invention is directed to a method and system for the quantification of repolarization changes when measured in a dynamic electrocardiogram ("ECG") signal. In an ECG signal, a modification of the T wave

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morphology can be observed when certain pharmaceutical agents are taken and also with certain types of cardiac disorders. In particular, it is known that prolongation of the QT interval in an ECG signal is clearly associated with an increased risk for ventricular arrhythmias and sudden cardiac death. Accordingly, prior systems have been developed to monitor the QT interval in ECG signals to detect potential heart problems. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Method and system for associating an EKG waveform with a CT image Inventor(s): Acharya, Kishore C.; (Brookfield, WI), Okerlund, Darin R.; (Muskego, WI), Woloschek, Steven J.; (Franklin, WI), Woodford, Mark E.; (Waukesha, WI) Correspondence: Cantor Colburn, Llp; 55 Griffin Road South; Bloomfield; CT; 06002 Patent Application Number: 20030216641 Date filed: May 17, 2002 Abstract: A method for associating EKG waveform data with computed tomography image data using a data synchronization scheme including generating the EKG waveform data using an electrocardiogram device, operating a computed tomography imaging system so as to create the computed tomography image data, communicating an exposure marker-in signal to the electrocardiogram device such that the exposure marker-in signal is associated with the EKG waveform data and processing the computed tomography image data, the EKG waveform data and the exposure marker-in signal, so as to correlate the EKG waveform data with the computed tomography image data. Also claimed is a medium encoded with a machine-readable computer program code for associating EKG waveform data with image data generated by an imaging system using a data synchronization scheme, the medium including instructions for causing controller to implement the aforementioned method. Excerpt(s): This invention relates generally to a method and system for synchronizing multiple data signals and more particularly to a method and system for synchronizing an EKG waveform generated via an electrocardiogram (EKG) with an x-ray image generated via a computed tomography (CT) imaging system. In many cardiac applications, it is desirable to have the ability to display a CT image of a patients' heart along with a simultaneously generated patient EKG waveform. This would allow a physician or technician to visually observe the physical condition of the patients' heart while simultaneously observing the cardiac electrical function of a patient. However, if the heart is moving or beating (cardiac motion) during the scanning process, the CT projection data may include motion artifacts and other noises making accurate reconstruction of the CT image more difficult, or in some cases impossible. One problem with this technique is that, although most EKG monitoring devices provide a means to read EKG waveform data as it is being collected, most CT imaging systems do not. As a result, a delay in time occurs between the collection of the EKG data and the collection of the CT projection data making accurate correlation between the EKG data and the CT projection data extremely difficult or impossible. Therefore, there is a need for a method that facilitates the correlation of EKG data and CT projection data, wherein the method utilizes existing CT imaging systems and EKG monitoring devices and wherein the method does not significantly increase the data collection time. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Method and system for measuring T-wave alternans by alignment of alternating median beats to a cubic spline Inventor(s): Findeis, Martin; (Freiburg, DE), Kaiser, Willi; (Emmendingen, DE) Correspondence: Fletcher, Yoder & Van Someren; P. O. Box 692289; Houston; TX; 772692289; US Patent Application Number: 20030069512 Date filed: October 5, 2001 Abstract: An electrocardiogram processing technique for measuring T-wave alternans by which the alternating electrocardiogram signals are aligned to a target cubic spline. The target cubic spline is calculated on base of three isoelectric points namely a point before the P-wave, a point before the QRS-complex and a point after the T-wave. The aligned signals may then be further analyzed for variations such as T-wave alternans which are only present in alternating beats and which have diagnostic significance. Excerpt(s): The present invention relates generally to the field of cardiology and, more particularly, to a method and system of processing an electrocardiogram signal to detect T-wave alternans by aligning alternating beats to a cubic spline. More accurate detection and quantification of alternans within the ST-segment and T-wave of the signal is then possible upon the aligned beats. In the field of electrocardiography, electrical alternans are the differences in electrical potential at corresponding points between alternate heartbeats. T-wave alternans or alternation is a regular beat-to-beat variation of the STsegment or T-wave of an ECG which repeats itself every two beats and has been linked to underlying cardiac instability. A patient's odd and even heartbeats may therefore exhibit different electrical properties of diagnostic significance which can be detected by an electrocardiogram (ECG). The presence of these electrical alternans is significant because patients at increased risk for ventricular arrythmias commonly exhibit alternans in the ST-segment and the T-wave of their ECG. Clinicians may therefore use these electrical alternans as a noninvasive marker of vulnerability to ventricular tacharrhythmias. The term T-wave alternans (TWA) is used to broadly denote these electrical alternans. It should be understood that the term encompasses both the alternans of the T-wave segment and the ST-segment of an ECG. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Method and system for processing electrocardiograms Inventor(s): Morganroth, Joel; (Gladwyne, PA) Correspondence: Duane Morris, Llp; Attn: William H. Murray; One Liberty Place; 1650 Market Street; Philadelphia; PA; 19103-7396; US Patent Application Number: 20030097077 Date filed: January 10, 2002 Abstract: In a method and system for processing an electrocardiogram (ECG), digital ECG data are received. The digital ECG data evinces a plurality of a patient's heartbeats detected during an ECG. Digital annotation data are generated representing marking to be shown on an ECG tracing of the plurality of heartbeats. An annotated ECG tracing image is produced using the digital ECG data and the digital annotation data. Excerpt(s): This invention relates to methods and systems for processing electrocardiograms, and more particularly to methods and systems for collecting and

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interpreting electrocardiograms developed during clinical trials. Over the past several years, the United States Food and Drug Administration (FDA.) and the United Kingdom regulatory authority (CPMP) have recommended that all new drugs have electrocardiogram (ECG) testing to determine any effects of the new agent on humans, particularly the effects on the QTc interval of a patient's ECG. Several companies support these clinical trials by serving as centralized collection and interpretation points or laboratories for the handling, analysis and data reporting of these ECGs (hereinafter referred to as "processing companies"). Most processing companies rely on ECG machines programmed with algorithms for measuring the important ECG intervals (such as the heart rate, PR, QRS, QT and QTc durations), and a cardiologist later reviews the intervals and interprets the ECG's morphology. Reliance on ECG machines for determining interval duration leads to inconsistent and inaccurate results, intrinsically as well as between different machine programs. Further, ECG machines have difficulty identifying low frequency waves, leading to false positive and false negative readings, especially with respect to the QT intervals. For several years, the assignee of the present application--eResearchTechnology, Inc. (eRT) of Philadelphia, Pa.--has been in the business of supporting clinical drug trials by providing centralized collection and interpretation of ECG services. The assignee, however, does not rely upon ECG machine measurements in measuring ECG intervals, but instead uses manual measurement techniques. This practice, although very accurate and reliable, further complicates the already cumbersome and paper-intensive process of generating regulatory-grade research data from ECG tracings for a sponsor of a clinical trial (i.e., data that are supported by an audit trail and are 100% verifiable by a government agency such as the FDA). An overview of this process is provided hereafter. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Method and system for terminating an atrial arrhythmia Inventor(s): Klein, George J.; (London, CA), Mehra, Rahul; (Stillwater, MN), Ujhelyi, Michael R.; (Maple Grove, MN) Correspondence: Girma Wolde-michael; Medtronic, INC., MS 301; 710 Medtronic Parkway; Mailstop Lc340; Minneapolis; MN; 55432; US Patent Application Number: 20030144701 Date filed: January 30, 2002 Abstract: A method and system is provided for responding, from internally within a patient, to an atrial arrhythmia in a heart including measuring from within the patient at least one electrocardiogram characteristic indicative of the atrial arrhythmia, and controlling from within the patient drug therapy delivery to the patient responsive to measuring the at least one electrocardiogram characteristic. Drug therapy is initiated to the patient responsive to measuring the at least one electrocardiogram characteristic. According to one aspect of the present invention, the drug therapy is staged within the patient prior to measuring the at least one electrocardiogram characteristic. According to another example embodiment, the heart is paced from within the patient at a predefined rate responsive to measuring the at least one electrocardiogram characteristic, pacing occurring alone, or in combination with drug therapy. Excerpt(s): The present invention relates to terminating atrial and ventricular fibrillations. In particular, the invention relates to terminating atrial fibrillation while preventing the occurrence of ventricular proarrhythmia (i.e., irregular ventricular rhythm). Implanted medical devices exist today that are capable of detecting and

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treating arrhythmia of a patient. In one example, the implanted medical device includes a defibrillator that applies an electrical therapy to a patient's heart upon detecting an atrial fibrillation. Cardioverters or defibrillators discharge relatively high energy electrical shocks across cardiac tissue to arrest a life threatening atrial or ventricular fibrillation that is detected by the implanted medical device. Defibrillation shocks, while highly effective at arresting the fibrillation, may cause considerable patient discomfort. Accordingly, there is a need for a method for terminating an arrhythmia that will not cause patient discomfort, the effectiveness of which can be easily verified by analyzing the patient's cardiac signal. An approach that addresses the aforementioned problems, as well as other related problems, is therefore desirable. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Method for chart markup and annotation in technical analysis Inventor(s): Escher, Richard E.A.; (Ottawa, CA) Correspondence: Borden Ladner Gervais Llp; World Exchange Plaza; 100 Queen Street Suite 1100; Ottawa; ON; K1p 1j9; CA Patent Application Number: 20030131315 Date filed: December 17, 2002 Abstract: A method for generating markup information and annotating a time series chart to display recognized pattern formations. Pivot points in the time series are identified and categorized. The pivot points are then analyzed to recognize desired pattern formations. The time series is then graphically displayed with the pivot points marked and labeled. Lines drawn between the pivot points display the recognized pattern to a user. Breakout (trend) lines can also be included. The time series can include time series of financial data, such as stock prices, medical data, such as electrocardiogram results, or any other data that can be presented as a time series, and in which it is desirable to identify turning points, trends, formations or other information. Excerpt(s): This application claims the benefit of priority from U.S. Provisional Application No. 60/339,774, filed Dec. 17, 2001. The present invention relates generally to technical analysis. More particularly, the present invention relates to a method of chart markup and annotation in technical analysis. Technical financial analysis, as opposed to fundamental analysis, uses the past price, volume activity, or other measures of a stock, or of a market as a whole, to predict the future direction of the stock or market. Technical analysis can also be applied to other time series such as medical data, electrocardiogram results, or any other data that can be presented as a time series, and in which it is desirable to identify turning points, trends, formations or other information. The results of a technical analysis are usually shown in charts or graphs that are studied by technical analysts to identify known trends and patterns in the data to forecast future performance. Recognizing patterns in the charts and graphs is greatly enhanced by efficient pattern recognition and automated chart annotation. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Method for diagnosing heart disease, predicting sudden death, and analyzing treatment response using multifractial analysis Inventor(s): Flick, James T.; (Little Rock, AR), Joseph, Jacob; (Little Rock, AR) Correspondence: Wright Lindsey & Jennings, Llp; 200 West Capitol Avenue; Suite 2200; Little Rock; AR; 722013699 Patent Application Number: 20030163057 Date filed: February 22, 2002 Abstract: A method of analyzing electrocardiogram (EKG) data for use in the diagnosis of heart disease, prognosis of cardiac conditions, and the monitoring of heart disease therapies is disclosed. The method utilizes a wavelet-based multifractal analysis with one or more of (1) a discrete wavelet smoothing step to remove the effects of abnormal beats; (2) "Levy flight" analysis to detect the frequency of abnormal beats known to adversely affect the multifractal (MF) analysis; and (3) MF alpha analysis, a multifractal extension of monofractal short term (ST) alpha analysis. The invention further comprises an EKG test battery comprising Levy flight anomalous beat/beat cluster screening, followed by (ST) MF alpha analysis and MF Holder analysis (when validated by the Levy flight analysis). The wavelet smoothing step can also be used to classify human EKGs by observing the effect of sequential smoothing on the MF Holder coefficient. Alternative choices to the wavelet smoothing approach to removal of abnormal beat effects include probability distribution function analysis to determine the MF Holder coefficient directly, abnormal beat ridge skeleton removal to remove the offending beats based on a direct multifractal spectrum calculation, and the calculation of various types of entropy coefficients for the EKG time series. Excerpt(s): The present invention is directed to a battery of multifractal-based tests developed for the analysis of electrocardiogram (EKG) data. The invention is preferably for clinical use in a novel integrated approach to diagnosis of heart disease, prognosis of cardiac conditions, and monitoring of heart disease therapies. This multifractal approach is not available with current, clinically available cardiographic methods. Cardiovascular disease currently affects approximately 20 million Americans. Roughly 12 million Americans are affected by coronary artery disease (CAD), and 5 million suffer from congestive heart failure (CHF). More importantly, millions suffer from undiagnosed heart disease; the prevalence of undiagnosed CHF is estimated to be approximately 20 million in the U.S. In addition, 400,000 Americans with CAD or CHF die from sudden cardiac death each year. Although there are a number of conventional nonfractal tests for the diagnosis of heart disease (several of them highly invasive), none of these tests can effectively predict which patients in this group of 17 million (CAD+CHF) are at risk of sudden death. Since it is impractical and undesirable to treat every person with heart disease (CAD or CHF) as if such a person were at risk for sudden death, a reliable predictive test (or test battery) to determine which patients are at high risk would be of great value. In addition, new drugs and other treatments continue to be developed to treat heart disease. There are, however, no currently available analytic test regimens to rapidly evaluate how well the patient may respond to treatment and whether the risk of sudden death has been decreased by anti-arrhythmic therapy. As a result, the efficacy of these treatments must be determined empirically with slow, multi-year, prospective-controlled studies, which are very difficult to extrapolate to each individual patient. Therefore, an analytic method that would monitor a patient for signs of potential improvement on therapy would also be of great value. The diagnosis of CAD and CHF would also be greatly improved by a very sensitive and specific but noninvasive test to replace or supplement expensive and

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invasive modalities like heart catheterization and allow screening of patients with asymptomatic heart disease. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Method of analysis of cardiovascular condition Inventor(s): Kramarenko, Alexander; (Kharkov, UA) Correspondence: Ilya Zborovsky; 6 Schoolhouse Way; Dix Hills; NY; 11746; US Patent Application Number: 20020193693 Date filed: June 18, 2001 Abstract: A method of analysis of cardiovascular condition, includes generating an electrocardiogram of a heart activity of a patient; and analyzing the generated electrocardiogram by determining a magnitude of a red shift of a signal spectrum. Excerpt(s): The present invention relates to method of analysis of cardiovascular conditions. It is known to determine heart conditions or generally conditions of a cardiovascular system by generating electrocardiogram and analyzing the latter. Accordingly, it is an object of the present invention to provide method of analysis of heart condition, which can be considered as more accurate than the existing methods. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Monitoring of patient's electrical characteristics Inventor(s): Rantala, Borje; (Helsinki, FI), Virtanen, Juha; (Helsinki, FI) Correspondence: Daniel D Fetterley; Andrus Sceales Starke & Sawall; 100 East Wisconsin Avenue Suite 1100; Milwaukee; WI; 53202-4178; US Patent Application Number: 20020183634 Date filed: July 10, 2002 Abstract: The invention relates to a method and a system for a medical monitoring system, in which method the functions of a patient are measured, and the change in the electric activity of the patient are observed. In the method, the electrocardiogram (EKG), electroencephalogram (EEG), and the impedance cardiograph signal (IKG) are being measured with one piece of measuring equipment. Excerpt(s): The invention relates to medical monitoring systems. In particular, the invention relates to the method as defined in the preamble of claim 1. Methods for monitoring the electric activity of a patient are becoming common. Previously known is a method for measuring the electrocardiogram (EKG). In measuring, electrodes are attached to the patient, and a small high-frequency current is conducted into them. By measuring the change in the voltage of the electrodes it is possible to observe the electric activity of the patient, and e.g. the muscle activity. The 12-switched system as shown in FIGS. 1 and 2 comprises signal conductors which are connected, according to the standard placement of electrodes, to the corresponding aforementioned measuring electrodes RA, LA, RL, LL, V.sub.1, V.sub.2, V.sub.3, V.sub.4, V.sub.5, V.sub.6 attached to the patient P. Each signal conductor comprises a connector apparatus. The signal conductors are further connected to the EKG equipment making the measurement. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Multi-electrode panel system for sensing electrical activity of the heart Inventor(s): Ransbury, Terrance; (Pleasanton, CA), Sippens Groenewegen, Arne; (Burlingame, CA) Correspondence: Townsend And Townsend And Crew, Llp; Two Embarcadero Center; Eighth Floor; San Francisco; CA; 94111-3834; US Patent Application Number: 20040015194 Date filed: February 10, 2003 Abstract: Improved systems, devices, and methods sense heart signals through a torso surface of a patient. These improved systems facilitate mounting of an array of sensors upon the patient's torso by supporting the sensor arrays on one or more panels. Four separate panels can be adapted for engaging the torso surface, with the four panels supporting most and/or all of the sensors necessary for localizing an arrhythmia within a chamber of a heart of a patient. The panels may have integrated components for use with other electrophysiology lab equipment such as cardiac imagers, defibrillation power sources, therapeutic probes, standard 12-lead electrocardiogram (ECG) systems, and the like. An exemplary arrhythmia sensing system is adapted for use in the highnoise environment of an electrophysiology lab includes a series of powered circuits distributed among the electrodes of the array. A separate low-noise environment sensing system may initially record an abnormal irregular or regular heartbeat outside the electrophysiology lab. Excerpt(s): This is a divisional patent application which claims priority from U.S. patent application Ser. No. 09/611,179 filed Jul. 6, 2000, which claims the benefit of priority from U.S. Provisional Patent Application No. 60/189,611 filed Mar. 15, 2000, and U.S. Provisional Patent Application No. 60/200,965 filed May 1, 2000, the full disclosures of which are incorporated herein by reference. The present invention generally relates to devices, systems, and methods for diagnosing and/or treating the heart. In particular, the invention provides methods and systems for sensing heart signals, and especially for localizing and/or treating arrhythmias. Significant progress has recently been made toward effective treatments of many cardiac arrhythmias. Contraction of a healthy human heart generally propagates through the heart tissue from the sinus node in the right atrium, and eventually the associated ventricles. This normal propagation of contraction forces blood to flow from the atria to the ventricles in a synchronized pumping action. Arrhythmias of the heart often originate at and/or propagate from alternative heart tissues, resulting in rapid irregular or regular contractions of some or all of the heart. Radiofrequency (RF) intracardiac catheter ablation of the alternative ectopic origin, an abnormal conduction pathway, or an abnormal pathway exit site is now used to effectively treat a variety of arrhythmias. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Patient monitor for determining a probability that a patient has acute cardiac ischemia Inventor(s): Bayer, Brian J.; (Menomonee Falls, WI), Bin Moin, Areef Ahmed; (Waukesha, WI), Van Ryzin, Patrick; (Pewaukee, WI) Correspondence: Michael Best & Friedrich, Llp; 100 E Wisconsin Avenue; Milwaukee; WI; 53202; US Patent Application Number: 20020133087 Date filed: January 11, 2001 Abstract: A patient monitor for determining a probability that a patient has acute cardiac ischemia including an input device connectable to a patient to acquire electrocardiogram (ECG) signals from the patient, an instrumentation amplifier connected to the input terminal to combine the signals and to generate at least one ECG lead, and an analysis module. The analysis module is operable to continuously read the ECG lead, to analyze a portion of the ECG lead for a period of time, and to calculate a probability that the patient has acute cardiac ischemia based at least in part on the analyzed portion of the ECG lead. Excerpt(s): The invention relates to a patient monitor and, particularly, a patient monitor for continuously monitoring one or more physiological signals of a patient and for determining a probability that a patient has acute cardiac ischemia based at least in part on one of the continuously monitored physiological signals. Every day, patients arrive at an emergency room of a hospital complaining of chest pain. The chest pain may be a symptom indicating the patient is experiencing a myocardial infarction or, alternatively, the chest pain may be a symptom indicating the patient is experiencing a lesser medical condition (e.g., heartburn or indigestion). Statistics show that quickly identifying whether a patient is having a myocardial infarction may minimize the amount of damage to the heart. However, performing the necessary tests to correctly determine whether a patient is experiencing the myocardial infarction or heartburn are expensive. One instrument used to predict whether a patient is likely experiencing a myocardial infarction is an electrocardiograph capable of calculating a probability that the patient has acute cardiac ischemia. If the patient has a high probability of acute cardiac ischemia, then the patient should be further tested to determine whether the patient is experiencing a heart attack. One instrument for determining a probability of a patient having acute cardiac ischemia is an Acute Cardiac Ischemia Time-insensitive Predictive Instrument (ACI-TIPI). ACI-TIPI is described in detail in Selker et al., A Tool for Judging Coronary Care Unit Admission Appropriateness, Valid for both Real-Time and Retrospective Use: Medical Care, Vol. 28, No. 7 July 1991), pp. 610-627 and Selker et al., Erratum: Medical Care, Vol. 30, No. 2 (February 1992), p. 188, both of which are incorporated herein by reference. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Process and implantable device for the intrapulmonary assessing of density dependant physical properties of the lung tissue Inventor(s): Marcelli, Emanuela; (Macerata, IT), Plicchi, Gianni; (Bologna, IT) Correspondence: Larson & Taylor, Plc; 1199 North Fairfax Street; Suite 900; Alexandria; VA; 22314; US Patent Application Number: 20020123674 Date filed: February 27, 2002 Abstract: The invention relates to an implantable device for therapeutic and diagnostic purposes, which is capable to detect the physical properties of the pulmonary tissue which depend from its density and their variations caused by a pathologic condition of the heart (heart failure, ischemia, arrhythmia), using one or more intrapulmonary catheters, provided with sensors, inserted in branches of the pulmonary artery. The catheters provided with sensors preferably use as sensors electrodes and the detected physical property, which depends by the density of the pulmonary tissue, is preferably the bioelectric impedance of the explored portion of lung. The same electrodes can be also used for monitoring of an electrocardiogram, without artefacts and interferences. The device can be used to guide and optimise the therapy of the heart disease made with electrostimulators and/or cardiac defibrillator and/or systems for the exhibition of drugs and/or for the drainage of the fluids accumulated in the body and/or for the circulatory assistance to the heart. The device comprises means for the communication with external devices by means of radio-frequency transmission. This invention constitutes a significative improvement in the state of the art of the implantable devices for the therapy and the diagnosis of the heart diseases, because it allows the measurement of the specific bioelectric impedance of the pulmonary tissue only, overcoming the drawbacks of the known systems, which by using surfaces electrodes placed upon the skin or electrodes placed inside of the heart cavities, give a measurement of the transthoracic impedance determined prevalently by the volume variations of the heart and great vessels and only partially of the contents of fluids in the pulmonary tissue. Excerpt(s): Heart failure is a serious pathologic condition of the heart, during which the amount of blood pumped by the heart is insufficient to satisfy the normal requirements of oxygen and nutrients of the body. Heart failure has several causes and is a complication of several diseases. Heart failure is more common in the older people because they are more predisposed to the primary pathologies which can be the cause of the same. Heart failure affects about 22,5 millions of persons world-wide and about 2 millions of new cases are diagnosed every year. Five millions of persons are affected by heart failure in the U.S.A., about six millions and half in Europe and about seven hundred and fifty-thousand in Italy. About the 70% of the patients with heart failure die because of said disease within ten years. Each disease which affects the heart and which interferes with the circulation of the blood, can lead to heart failure. By far the most common disease which can lead to the heart failure is represented by the coronary disease, which reduces the blood flow to the heart and produces an infarct which can damage the cardiac muscle. This disease is predisposed by diabetes, hyperthyroidism or obesity. Diseases of the cardiac valves may obstruct the flow between the chambers of the heart and the aorta and in contrast, a defective valve produces a retrograde haematic flow. These situations increase the workload of the heart which can dilate and reduce its functionality. Other diseases can affect the electric conduction system of the heart and may cause alteration of the rhythm, which can lead to a myocardial hypertrophy, like any muscle after months of exercise. Initially this dilatation allows a more strong

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contraction, but a further dilatation may lead to a reduced contractile capacity and to a heart failure. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Programmable wireless electrode system for medical monitoring Inventor(s): Ghaem, Sanjar; (Chesapeake, VA), Khair, Mohammad; (Hoffman Estates, IL), Lopez, Salvador; (Park Ridge, IL), Ng, Richard; (Cary, IL), Olson, William L.; (Lake Villa, IL) Correspondence: Craig A. Summerfield; Brinks Hofer Gilson & Lione; P.O. Box 10395; Chicago; IL; 60610; US Patent Application Number: 20030040305 Date filed: October 22, 2002 Abstract: A wireless, programmable system for bio-potential signal acquisition (e.g., electrocardiogram (ECG) data) includes a base unit and a plurality of individual wireless, remotely programmable transceivers that connect to patch electrodes. The base unit manages the transceivers by issuing registration, configuration, data acquisition, and transmission commands using wireless techniques. Bio-potential signals from the wireless transceivers are demultiplexed and supplied via a standard interface to a conventional monitor for display. Excerpt(s): This invention relates generally to the field of devices used to measure and display bio-potential signals generated by the body. More particularly, the invention relates to a plurality of wireless, remotely programmable electrode transceiver assemblies that are each coupled to a conventional patch electrode, and an associated base unit. The base unit obtains a patient's electrocardiogram (ECG) or other biopotential signal from the wireless transceivers and supplies the signal to a monitor unit for display. The display may be a standard ECG monitor. Conventional ECG apparatus for hospital bedside monitoring typically requires up to ten wired electrodes. Each electrode is attached to the body of the patient, and has a wire, several feet or more in length, leading to an ECG monitor. Such electrodes are used to detect heart signals from the patient and convert them into a multiple-lead ECG evaluation. The lengthy wired electrodes of conventional ECG apparatus obstruct the patient and limit the patient's freedom of movement. They are also cumbersome for the physician or assisting nurse. Telemetry systems for wireless ECG monitoring for patients in hospitals currently exist. These systems are more expensive, intended for greater range (higher power), and do not totally eliminate the physical electrode wires attached to the patient. Instead of being connected to the monitor, the electrodes are each wired to a single transmitter box that is worn by the patient. Some telemetry systems also may not handle a 12 lead ECG (10 wires) because of the wiring that is required between the electrodes and the transmitter box. For example, the Spacelabs Ultraview Modular Digital Telemetry system can only handle a maximum of four leads (5 wires). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Pulse detection apparatus, software, and methods using patient physiological signals Inventor(s): Crone, William E.; (Fall City, WA), Hampton, David R.; (Woodinville, WA), Jayne, Cynthia P.; (Redmond, WA), Joo, Tae H.; (Redmond, WA), Lank, Paula; (Renton, WA), O'Hearn, Patricia; (Mercer Island, WA), Stickney, Ronald E.; (Edmonds, WA), Taylor, James W.; (Sammamish, WA), Yerkovich, Daniel; (Seattle, WA) Correspondence: Christensen, O'connor, Johnson, Kindness, Pllc; 1420 Fifth Avenue; Suite 2800; Seattle; WA; 98101-2347; US Patent Application Number: 20030060723 Date filed: August 26, 2002 Abstract: The presence of a cardiac pulse in a patient is determined by evaluating physiological signals in the patient. In one embodiment, a medical device evaluates two or more different physiological signals, such as phonocardiogram (PCG) signals, electrocardiogram (ECG) signals, patient impedance signals, piezoelectric signals, and accelerometer signals for features indicative of the presence of a cardiac pulse. Using these features, the medical device determines whether a cardiac pulse is present in the patient. The medical device may also be configured to report whether the patient is in a VF, VT, asystole, or PEA condition, in addition to being in a pulseless condition, and prompt different therapies, such as chest compressions, rescue breathing, defibrillation, and PEA-specific electrotherapy, depending on the analysis of the physiological signals. Auto-capture of a cardiac pulse using pacing stimuli is further provided. Excerpt(s): This application is a continuation-in-part of U.S. patent application Ser. No. 09/410,198, filed Sep. 30, 1999, and U.S. patent application Ser. No. 10/013,941, filed Dec. 6, 2001, priority from the filing dates of which is hereby claimed under 35 U.S.C.sctn. 120. The invention relates generally to the detection of cardiac activity in a patient, and more specifically, to the detection of a cardiac pulse and the use of pulse detection in delivering therapy. The lack of a detectable cardiac pulse in a patient is a strong indicator of cardiac arrest. Cardiac arrest is a life-threatening medical condition in which the patient's heart fails to provide enough blood flow to support life. During cardiac arrest, the electrical activity may be disorganized (ventricular fibrillation), too rapid (ventricular tachycardia), absent (asystole), or organized at a normal or slow heart rate without sufficient blood flow (pulseless electrical activity). A caregiver may apply a defibrillation shock to a patient in ventricular fibrillation (VF) or ventricular tachycardia (VT) to stop the unsynchronized or rapid electrical activity and allow a perfusing rhythm to return. External defibrillation, in particular, is provided by applying a strong electric pulse to the patient's heart through electrodes placed on the surface of the patient's body. If a patient lacks a detectable pulse but has an ECG rhythm of asystole or pulseless electrical activity (PEA), conventional therapy may include cardiopulmonary resuscitation (CPR), which causes some blood flow. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Signal evaluation method for detecting QRS complexes in electrocardiogram signals Inventor(s): Kohler, Bert-Uwe; (Berlin, DE), Orglmeister, Reinhold; (Berlin, DE) Correspondence: Browdy And Neimark, P.L.L.C.; 624 Ninth Street, NW; Suite 300; Washington; DC; 20001-5303; US Patent Application Number: 20020133085 Date filed: February 7, 2002

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Abstract: A signal evaluation method for detecting QRS complexes in electrocardiogram (ECG) signals comprises the following steps:sampling of the ECG signal (4) and conversion into discrete signal values (x(n)) in chronological order;comparing the signal values (x.sub.f(n), x.sub.fq(n)) to a threshold function (K(n)) adaptively determined therefrom;determining a frequency number (D(n)) within a defined segment of the consecutive signal values, by which signal values (x.sub.f(n), x.sub.fq(n)) preferably fall short of the threshold function (K(n));comparing the determined frequency number (D(n)) to a defined threshold (.THETA.), wherein an undershoot of the threshold (.THETA.) is significant for apresence of a QRS complex (5, 6, 7) in the defined segment of the ECG signal (4). Excerpt(s): The invention relates to a signal evaluation method for detecting QRS complexes in electrocardiogram (ECG and IEGM) signals. Regarding the background of the invention, it can be stated that the automatic analysis of ECG signals is playing an increasingly larger role in perfecting the functionality of cardiac pacemakers and defibrillators. Newer models of implantable cardiac devices of this type accordingly also offer the capability to perform an ECG analysis. The detection of QRS complexes and R spikes in ECG signals plays an extremely important role in this context. This significance results from the many and diverse applications for the information concerning the time of occurrence of the QRS complex, for example when examining the heart rate variability, in the classification and data compression, and as the base signal for secondary applications. QRS complexes and R spikes that are not detected at all or detected incorrectly pose problems with respect to the efficiency of the processing and analysis phases following the detection. A wide overview of known signal evaluation methods for detecting QRS complexes in ECG signals can be found in the technical essay by Friesen et al. "A Comparison of the Noise Sensitivity on Nine QRS Detection Algorithms" in IEEE Transaction on Biomedical Engineering, Vol. 37, No. 1, January 1990, pages 85-98. The signal evaluation algorithms presented there are based throughout on an evaluation of the amplitude, the first derivation of the signal, as well as its second derivation. For the presented algorithms, the essay distinguishes between those that perform an analysis of the amplitude and the first derivation, those that analyze only the first derivation, and those that take into consideration the first and second derivation. To summarize briefly, all algorithms check whether the given signal parameter exceeds or falls short of any predetermined thresholds, after which, if such an event occurs, the occurrence of additional defined events is checked based on a predefined pattern, and if certain criteria are fulfilled, the conclusion is drawn that a QRS complex is present. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

System and method for predicting the onset of cardiac pathology using fractal analysis Inventor(s): Schreck, David M.; (Summit, NJ) Correspondence: Greenberg Traurig, Llp; 21st Floor; 885 Third Avenue; New York; NY; 10022; US Patent Application Number: 20040002661 Date filed: July 1, 2002 Abstract: The onset of cardiac pathology can be predicted by first acquiring a plurality of lead values as a function of time for set of electrocardiogram leads and defining a spatial curve from the lead values for at least three leads. A fractal index for the spatial

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curve is calculated as a function of time and the time rate of change of the fractal index is monitored. A negative time rate of change is indicative of normal cardiac activity, while a positive time rate of change is indicative of pathological cardiac activity. Excerpt(s): This invention is directed to the prediction of acute cardiac activity from the fractal analysis of spatial loops generated from the synthesized leads of an electrocardiogram ("ECG") derived from three measured leads belonging to the set of routinely used leads, including the standard 12-lead ECG. The ECG is a record of the electrical activity of the heart that is a commonly used diagnostic screening test in many medical settings. The standard ECG record includes 12 lead waveforms, denoted as I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, and V6, arranged in a specific order that is interpreted by a physician using pattern recognition techniques. The ECG is acquired by physicians, nurses or other specially trained technicians using specialized hardware and equipment. In the usual configuration, 10 electrodes are placed on the body torso to measure the electrical potentials that define the standard 12 leads. Other lead systems have been tested over the years. These include the Frank vectorcardiogram ("VCG") system, which uses 3 nearly orthogonal leads denoted as X, Y, and Z; 4 right chest leads, denoted by V3R, V4R, V5R, and V6R; and 3 left posterior leads, denoted as V7, V8, and V9. No single manufacturer currently makes equipment that allows for the acquisition of all 22 leads. In order to acquire these leads, the technician must first remove the lead clips attached to the standard electrode placement sites and then re-attach them on the electrodes placed on the non-conventional sites. This requires at least 3 separate tracing acquisitions and a total of 21 electrode placements. It is usual in the practice of medicine to place patients with potential cardiac abnormalities on a rhythm monitor, a specially designed hardware equipment that displays only one ECG lead but which has the capability of measuring 3 different leads. There are some manufacturers who have designed rhythm monitors that can display three leads as well but the usual display format is still one lead. With this equipment, the patient has 3 to 4 electrodes placed on the body torso to acquire the 3 different lead configurations. While the patient is connected to the rhythm monitor, if a standard 12 lead ECG is ordered, the technician will then place all of the additional electrodes for the separate acquisition of the ECG. Thus, the efficiency of acquiring an ECG would be improved if there existed a process by which the standard 12 lead ECG, the 3 lead VCG, the 4 right chest leads, or the 3 left posterior leads could be acquired instantaneously on demand from the rhythm monitor rather than the usual ECG machine, using fewer than standard number of electrodes. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

System for adaptively deriving ECG chest lead signal data Inventor(s): Meij, Simon H.; (Delft, NL), Nelwan, Stefan P.; (As Rotterdam, NL), Tabbara, Besher; (Malden, MA) Correspondence: Jack J. Schwartz & Associates; 1350 Broadway; Suite1507; New York; NY; 10018-7702; US Patent Application Number: 20040030257 Date filed: November 1, 2002 Abstract: A system provides synthesized chest lead signals of a conventional 12 lead electrocardiogram (ECG) signal set. The system adaptively derives ECG chest lead signals for a plurality of the six ECG chest lead signals of a conventional 12 lead ECG signal set. The system includes an input processor for receiving data comprising two measured ECG chest lead signals comprising a particular two of the six ECG chest lead

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signals of a conventional 12 lead ECG signal set and receiving associated information identifying the particular two signals of the six ECG chest lead signals. A data processor in the system uses the information identifying the particular two signals of the six ECG chest lead signals for identifying and selecting coefficients from a plurality of stored coefficients and applying a transformation using the selected coefficients to the data comprising the two measured ECG chest lead signals to derive data representing a plurality of non-measured ECG chest lead signals. An output processor processes the data representing the plurality of non-measured ECG chest lead signals for output. The selected coefficients are patient non-specific. Excerpt(s): This is a non-provisional application of provisional application serial No. 60/402,791 by B. Tabbara et al. filed Aug. 12, 2002. The present invention relates to electrocardiogram (ECG) systems, and in particular to ECG systems which can provide synthesized signals corresponding to, and substituting for, signals provided from electrodes attached to standard body chest positions employed in a conventional 12 lead ECG signal set. ECG systems are well known, and provide information about the physiological status of a patient's heart to a physician. More specifically, so called conventional 12 lead ECG systems exist which provide twelve waveforms, called leads (lead signals), to a physician. To provide such a 12 lead ECG, ten electrodes are placed on the patient's body, and the signals from these electrodes are processed to provide twelve lead signals in a known manner. These ten electrodes include four electrodes which provide signals that are processed to generate six limb lead signals, and six electrodes which provide signals that are processed to provide precordial or chest leads. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

System for analysis of biological voltage signals Inventor(s): Guerrero, Juan C.; (Durham, NC), Guerrero, Juan R.; (Durham, NC) Correspondence: Nixon & Vanderhye P.C.; 8th Floor; 1100 North Glebe RD.; Arlington; VA; 22201-4714; US Patent Application Number: 20020138013 Date filed: February 21, 2002 Abstract: Method of analyzing biological signals, including obtaining a magnetic recording media having an analog biological signal recorded thereon, using digital processing software to digitize the biological signal, displaying the digitized biological signal in analog form on a display, and visually analyzing the biological signal on the display. The biological signal may be an electrocardiogram. Preferably, independent channel enhancement of the dynamic range of the analog biological signal is performed prior to digitizing The displayed biological signal is preferably presented in time compressed form. Digitizing is performed by sampling the biological signal at at least approximately 44,100 Hz per second per channel and quantization of at least 16-bits per sample per channel. The digital processing software is preferably digital audio processing software. Excerpt(s): This application hereby claims priority on U.S. Provisional Application No. 60/103,154 filed Oct. 5, 1998, the disclosure of which is hereby incorporated by reference herein in its entirety. The instant invention relates to improved methods and systems for analysis of dynamic electrocardiograms and other similar waves of biological origin with the purpose of facilitating improved diagnosis of pathological states in human and veterinary medicine. More particularly, the instant invention advantageously uses

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advances in sound wave technology to improve the recovery, preservation, enhancement and cost effective analysis of biological signals to aid research as well as medical and veterinary diagnosis. Coronary heart disease is the main cause of death in many countries. About 50% of those affected do not reach the hospital due to poor recognition of the disease before a cataclysmic, often terminal event has occurred. The present invention facilitates improved recognition of myocardial ischemia in and out of the hospital by lay people with minimum training. Once the nature of the event is recognized, prompt treatment can then be obtained with a net effect in the decrease of morbidity and mortality and thereby providing substantial gains in life span and in quality of life. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

System, method, program, and medium for measuring heart rate Inventor(s): Yanagidaira, Masatoshi; (Tsurugashima-shi, JP), Yasushi, Mitsuo; (Tsurugashima-shi, JP) Correspondence: Morgan Lewis & Bockius Llp; 1111 Pennsylvania Avenue NW; Washington; DC; 20004; US Patent Application Number: 20040044292 Date filed: August 28, 2003 Abstract: A heart-rate measuring apparatus is provided a database, acquisition unit, production unit, search unit, cross-correlation processing unit, and calculation unit. In the database, one or more sets of electrocardiogram (ECG) waveform data, serving as reference waveform data, of persons being examined are stored in advance. The acquisition unit acquires a heartbeat signal from a person being examined. The production unit produces ECG waveform data based on the acquired heartbeat signal. On the basis of the produced ECG waveform data, the search unit searches the database for reference waveform data of the person. The cross-correlation processing unit performs cross-correlation processing between the produced ECG waveform data and the searched reference waveform data, and the calculation unit calculates the heart rate based on the cross-correlated ECG waveform data using values of R-R intervals of the waveform. Excerpt(s): The present invention relates to a method and system for measuring a heart rate of an object, such as a person to be examined, on the basis of a heartbeat signal acquired from the object. In recent years, applications of an electrocardiogram data indicative of the diastolic and systolic actions of the heart have been spread into various fields. Because it has been found that the influence of stress and fatigue caused in the human has come out as fluctuations in a heart rate or heart rate variability, the electrocardiogram data has been used in the field of human engineering and medical industry as well as the field of medical care, such as finding and diagnosis of cardiovascular diseases and monitoring medical conditions. Therefore, it is a recent demand to commercialize compact measurement apparatuses capable of measuring an amount of the heart rate and information in relation to heart rate variability. As to the conventional measurement of the heart rate, there has been known an electrocardiogram analysis apparatus that is able to compute the heart rate based on a heart rate signal appearing due to excitation at the atrium of the heart. This type of electrocardiogram analysis apparatus is represented by the apparatus disclosed by Japanese Patent-laid Open (KOKAI) publication No. 1995-016214.

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Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Temporary heart-assist system Inventor(s): Frazier, O. Howard; (Houston, TX) Correspondence: Gardere Wynne Sewell Llp; Suite 3400; 1000 Louisiana; Houston; TX; 77002-5007; US Patent Application Number: 20030191357 Date filed: March 26, 2002 Abstract: A balloon is positionable in the patient's descending aorta. The balloon includes a balloon catheter and two pressure sensors that electrically couple to an extracorporeal controller. The balloon itself also couples pneumatically to the extra-corporeal controller. An extra-corporeal pump electrically couples to the extra-corporeal controller, the pump having an outlet connectable to the patient's infra-diaphragmatic artery. The pump inlet is connectable via a cannula to the patient's supra-diaphragmatic artery.A doctor inserts the balloon into the descending aorta, and positions the balloon near the level of the patient's diaphragm. A balloon catheter, coupled to the extracorporeal controller, inflates and deflates the balloon. An electrocardiogram ECG and proximal aortic blood pressure, measured in the upper arterial compartment via a lumen in the balloon catheter, serve as inputs to cycle the balloon synchronously with the heartbeat. Excerpt(s): The present invention relates generally to methods and devices for mechanically assisting the failing heart. More specifically, it relates to balloon catheters and bypass pumps. Many types of cardiac assist devices have been developed over the past 40 years. The general types of devices can be characterized as short-term (hours to days), bridge-to-transplantation, bridge-to-recovery, and permanent or long-term. The goal of these devices is to mechanically support the failing heart by increasing systemic perfusion, and/or reducing the workload of the failing heart, thus creating the most favorable environment for cardiac recovery. The basic components of the intra-aortic balloon pump ("IABP") are a catheter tipped with a long balloon and a pump console that shuttles helium gas through the catheter to inflate and deflate the balloon synchronously with the heart beat. The balloon is inserted into an artery and guided to a position in the descending thoracic aorta just distal to the left subclavian artery. The pump control console contains signal processing, drive, timing, and control mechanisms for appropriate inflation and deflation. During cardiac systole ventricular contraction and ejection, the IABP is rapidly deflated, reducing the workload and oxygen demands of the heart by decreasing the resistance to blood flow from the ventricle. During cardiac diastole ventricular relaxation and filling, the IABP is rapidly inflated counter-pulsation increasing aortic and coronary perfusion pressures. Timing of the inflation-deflation cycle is based on the electrocardiogram and arterial blood pressure waveform. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Universal electrocardiogram sensor positioning mask with repositionable sensors and method for employing same Inventor(s): Wenger, William K.; (Laguna Niguel, CA) Correspondence: Bruce & Mccoy; One Kaiser Plaza, STE. 2360; Oakland; CA; 94612; US Patent Application Number: 20030130585 Date filed: January 9, 2002 Abstract: A universal disposable ECG sensor positioning device and method for use with electrocardiogram diagnostic equipment in which the mask has six sensors, two of which are movable, to provide four different sizes to accommodate varying sized human torsos. Excerpt(s): This is a related application to U.S. patent application Ser. No. 09/461,701, filed Dec. 14, 1999, for A Universal Electrocardiogram Sensor Positioning Device and Method, which is a continuation of U.S. Pat. No. 6,006,125, issued Dec. 21, 1999. The present invention relates to a disposable dermal chest mask for assistance in establishing electrical communication between sensors on a human chest and electrocardiograph machines. More particularly, it relates to a universal electrocardiogram sensor positioning device and method for all adult sizes including size extra large. Diagnostic medical equipment increasingly relies upon electrical contact with specific areas of the human body for evaluating the health status of patients. One of the most utilized and relied upon diagnostic tools is the electrocardiogram, sometimes referred to as an ECG. Leads or signal wires from the analytical apparatus are attached to a metallic or otherwise conductive body sensor electrode which is attached to the patient's skin at the desired points of contact. Electrical current generated by the heart in a person's chest flows to the surface and at the skin produces differences in electrical voltage which can be measured between pairs of electrodes placed at two points on the skin. A twelve-lead electrocardiograph provides the most accurate signals for recognizing ischemic electrocardiographic changes. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Voltage sensing system with input impedance balancing for electrocardiogram (ECG) sensing applications Inventor(s): Yonce, David J.; (Fridley, MN) Correspondence: Schwegman, Lundberg, Woessner & Kluth, P.A.; P.O. Box 2938; Minneapolis; MN; 55402; US Patent Application Number: 20020183635 Date filed: July 18, 2002 Abstract: A voltage sensing system includes input impedance balancing for electrocardiogram (ECG) sensing or other applications, providing immunity to common-mode noise signals while capable of use with two electrodes. Signals are received at first and second electrodes having associated impedances. An impedance circuit includes a feedback controller that adjusts an effective impedance associated with the second electrode based on a difference signal, a common mode signal, a phaseshifted (e.g., quadrature common mode) signal, and an impedance associated with the first electrode. As a result, signals associated with each electrode undergo a similar degree of gain/attenuation and/or phase-shift. This reduces common mode noise and

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enhances the signal-to-noise characteristics of a desired ECG or other output signal, without requiring the use of more than two electrodes. Excerpt(s): This application is a division of U.S. patent application Ser. No. 09/765,722, filed on Jan. 18, 2001, which is a continuation of U.S. patent application Ser. No. 09/243,265, filed on Feb. 3, 1999, now issued as U.S. Pat. No. 6,208,888, the specifications of which are hereby incorporated by reference. This invention relates generally to a voltage sensing system and particularly, but not by way of limitation, to a voltage sensing system with input impedance balancing for electrocardiogram (ECG) sensing applications. When functioning properly, the human heart maintains its own intrinsic rhythm, and is capable of pumping adequate blood throughout the body's circulatory system. The body's autonomous nervous system generates intrinsic electrical heart activity signals that are conducted to atrial and ventricular heart chambers on the left and right sides of the heart. The electrical heart activity signals trigger resulting heart contractions that pump blood. 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 electrocardiogram, 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 “electrocardiogram” (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 electrocardiogram. You can also use this procedure to view pending patent applications concerning electrocardiogram. 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 ELECTROCARDIOGRAM Overview This chapter provides bibliographic book references relating to electrocardiogram. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on electrocardiogram include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

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

A Practical Guide to the Use of the High-Resolution Electrocardiogram by Edward J. Berbari, Jonathan S. Steinberg; ISBN: 087993445X; http://www.amazon.com/exec/obidos/ASIN/087993445X/icongroupinterna

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An Atlas of Cardiology: Electrocardiograms and Chest X-rays by Neville Conway MB FRCP; ISBN: 0723415501; http://www.amazon.com/exec/obidos/ASIN/0723415501/icongroupinterna

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An introduction to automated electrocardiogram interpretation by Peter W. Macfarlane; ISBN: 0407218998; http://www.amazon.com/exec/obidos/ASIN/0407218998/icongroupinterna

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Computerized Interpretation of the Electrocardiogram by Michael M. Laks (Editor), Engineering Foundation; ISBN: 0939204193; http://www.amazon.com/exec/obidos/ASIN/0939204193/icongroupinterna

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Computerized Interpretation of the Electrocardiogram by James J. Bailey (Editor); ISBN: 0939204266; http://www.amazon.com/exec/obidos/ASIN/0939204266/icongroupinterna

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Computerized Interpretation of the Electrocardiogram by Ronald H. Selvester (Editor), David Geselowitz (Editor); ISBN: 0939204231; http://www.amazon.com/exec/obidos/ASIN/0939204231/icongroupinterna

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Computerized interpretation of the electrocardiogram : proceedings of the 1981 Engineering Foundation Conference, April 26-May 1, 1981, Miramar Hotel, Santa Barbara, California; ISBN: 0939204169; http://www.amazon.com/exec/obidos/ASIN/0939204169/icongroupinterna

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Differential Diagnosis of the Electrocardiogram by Sidney R. Arbeit; ISBN: 0803602413; http://www.amazon.com/exec/obidos/ASIN/0803602413/icongroupinterna

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ECG case studies : all new, 100 challenging electrocardiograms by Julian Frieden; ISBN: 0874880033; http://www.amazon.com/exec/obidos/ASIN/0874880033/icongroupinterna

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Electrocardiogram in Infants and Children: A Systematic Approach by Arthur Garson; ISBN: 0812108728; http://www.amazon.com/exec/obidos/ASIN/0812108728/icongroupinterna

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Electrocardiogram Interpretation and Emergency Intervention by Madeline Dignan Fassler, Barbara Tueller Steuble; ISBN: 0874343348; http://www.amazon.com/exec/obidos/ASIN/0874343348/icongroupinterna

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Electrocardiogram Technician (Smith's Career Notes Series) by Ronald R. Smith; ISBN: 1568750048; http://www.amazon.com/exec/obidos/ASIN/1568750048/icongroupinterna

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Electrocardiograms; ISBN: 0815102992; http://www.amazon.com/exec/obidos/ASIN/0815102992/icongroupinterna

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Electrocardiograms: A Systematic Method of Reading Them by Michael L. Armstrong; ISBN: 0074702483; http://www.amazon.com/exec/obidos/ASIN/0074702483/icongroupinterna

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Electrocradiography: A Programmed Text: Principles of Electrocardiography and Interpretation of Electrocardiograms by Samuel Griffith Owen; ISBN: 0316677248; http://www.amazon.com/exec/obidos/ASIN/0316677248/icongroupinterna

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Generation and Interpretation of the Electrocardiogram by Robert Paine; ISBN: 0812111311; http://www.amazon.com/exec/obidos/ASIN/0812111311/icongroupinterna

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Interpretation of Electrocardiograms by Nora Laiken, et al; ISBN: 0838540473; http://www.amazon.com/exec/obidos/ASIN/0838540473/icongroupinterna

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Interpretation of Electrocardiograms: A Self Instructional Approach by Nora Laiken (Editor), et al; ISBN: 0881673889; http://www.amazon.com/exec/obidos/ASIN/0881673889/icongroupinterna

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Interpretation of the Electrocardiograms; ISBN: 083854309X; http://www.amazon.com/exec/obidos/ASIN/083854309X/icongroupinterna

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Interpretation of the Electrocardiograms: A Review for Health Professionals by Karen Milazzo Jones; ISBN: 0838540392; http://www.amazon.com/exec/obidos/ASIN/0838540392/icongroupinterna

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Interpreting Electrocardiograms: Using Basic Principles and Vector Concepts (Fundamental and Clinical Cardiology, Number 42) by J. Willis Hurst; ISBN: 0824705130; http://www.amazon.com/exec/obidos/ASIN/0824705130/icongroupinterna

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Interpreting the Electrocardiogram by J. Fleming; ISBN: 0906141052; http://www.amazon.com/exec/obidos/ASIN/0906141052/icongroupinterna

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Normal conduction system and the electrocardiogram : a programmed instruction unit by Nancy Fairchild Clark; ISBN: 0803618409; http://www.amazon.com/exec/obidos/ASIN/0803618409/icongroupinterna

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Our Most Beloved Electrocardiograms - Nuestros Electrocardiogramas Mas Queridos by Josep Brugada, et al; ISBN: 8479038446; http://www.amazon.com/exec/obidos/ASIN/8479038446/icongroupinterna

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Parliament, judiciary, and parties : an electrocardiogram of politics by Madhu Limaye; ISBN: 8120204107; http://www.amazon.com/exec/obidos/ASIN/8120204107/icongroupinterna

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Performing the Electrocardiogram by Brian H Baker; ISBN: 0398046514; http://www.amazon.com/exec/obidos/ASIN/0398046514/icongroupinterna

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Rapid Analysis of Electrocardiograms: A Self-Study Program by Emanuel Stein, et al; ISBN: 0683306561; http://www.amazon.com/exec/obidos/ASIN/0683306561/icongroupinterna

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The 12 Lead Electrocardiogram by Leo Schamroth; ISBN: 0632022035; http://www.amazon.com/exec/obidos/ASIN/0632022035/icongroupinterna

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The Ekg--Basic Techniques for Interpretation: A Practical Guide for Interpreting and Analyzing the Electrocardiogram by Jerome. Passman; ISBN: 0070487154; http://www.amazon.com/exec/obidos/ASIN/0070487154/icongroupinterna

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The Electrocardiogram in Acute Myocardial Infarction by Ian P. Clements (Editor); ISBN: 0879936932; http://www.amazon.com/exec/obidos/ASIN/0879936932/icongroupinterna

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The Electrocardiogram: An Illustrated Manual by Rainer Klinge; ISBN: 0865772797; http://www.amazon.com/exec/obidos/ASIN/0865772797/icongroupinterna

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The Rat Electrocardiogram in Pharmacology and Toxicology: Proceedings of an International Workshop Held in Hannover, Federal Republic of Germany, July by R. Budden; ISBN: 0080268676; http://www.amazon.com/exec/obidos/ASIN/0080268676/icongroupinterna

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Trends in computer-processed electrocardiograms : proceedings of the IFIP Working Conference on Trends in Computer-Processed Electrocardiograms; ISBN: 0720407230; http://www.amazon.com/exec/obidos/ASIN/0720407230/icongroupinterna

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Understanding the Electrocardiogram: A New Approach: Section Two by Derek J. Rowlands; ISBN: 0906923077; http://www.amazon.com/exec/obidos/ASIN/0906923077/icongroupinterna

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Uses of the electrocardiogram : report on a WHO study; ISBN: 928901203X; http://www.amazon.com/exec/obidos/ASIN/928901203X/icongroupinterna

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

All Chest Pain Is Not Heart Pain Source: in Janowitz, H.D. Indigestion: Living Better with Upper Intestinal Problems from Heartburn to Ulcers and Gallstones. New York, NY: Oxford University Press. 1992. p. 107-114. Contact: Available from Oxford University Press. Order Department, 2001 Evans Road, Cary, NC 27513. (800) 451-7556. Fax (919) 677-1303. PRICE: $11.95 plus shipping and handling. ISBN: 019508554X. Summary: This chapter on chest pain is from a book that offers advice on how to take care of and avoid the whole complex of disturbances categorized as indigestion. The author first differentiates the symptoms of anterior (frontal) chest pain (which arises from the esophagus) from true angina (pain arising from the heart). Esophageal pain has nothing to do with effort or walking or climbing stairs; it can occur at night while a person is at rest or even awaken the person from sleep; swallowing disorders can also cause this severe pain. The common esophageal causes of the chest pain that may imitate the angina of heart disease are gastroesophageal reflux of gastric acid into the esophagus; disturbances in the motility function of the esophagus; and irritable esophageal syndrome. The author considers each of these conditions, noting their symptoms, diagnosis, and treatment, and stressing that if the patient's electrocardiogram, stress testing, and angiogram are negative, their hearts are healthy and the patient's chest pain can be treated as reflux or esophageal pain. Since the treatment of reflux and other esophageal pain is usually successful, the author suggests a vigorous trial of all antireflux methods and acid blocking techniques before proceeding to tests for microvascular angina.

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Genetic Counselling for Hearing Impairment Source: in Martini, A.; Read, A.; Stephens, D., eds. Genetics and Hearing Impairment. San Diego, CA: Singular Publishing Group, Inc. 1996. p. 255-264. Contact: Available from Singular Publishing Group, Inc. 401 West 'A' Street, Suite 325, San Diego, CA 92101-7904. (800) 521-8545 or (619) 238-6777. Fax (800) 774-8398 or (619) 238-6789. E-mail: [email protected]. Website: www.singpub.com. PRICE: $54.00 plus shipping and handling. ISBN: 1565937929. Summary: This chapter on genetic counseling for hearing impairment is from a book that offers an overview of genetic hearing loss for audiologists, otolaryngologists, and clinical geneticists. For most parents who have a child born with a hearing impairment, it occurs unexpectedly, in the absence of a family history of the disorder. Gene counseling is the process which addresses the common questions of why the child has a hearing impairment and what are the chances of another child to be born similarly

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affected. Genetic counseling requires consideration of the family history, the medical and obstetric history of the mother of the person with a hearing impairment, along with a detailed assessment of the physical findings in the affected individual and specialist investigations and examinations. The author begins with a brief outline of the epidemiology of hearing impairment, then discusses etiology (causes), assessment, the genetic counseling session itself, and the importance of counseling adults with hearing impairment. Diagnostic tools discussed include audiometry, ophthalmological examination, electrocardiogram, urinalysis, serology, cochlear computerized tomography (CT scan), and chromosomal analysis. 2 tables. •

Exercise Prescription Source: in Devlin, J.T. and Schneider, S.H., eds. Handbook of Exercise in Diabetes. Alexandria, VA: American Diabetes Association. 2002. p. 269-288. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. Website: www.diabetes.org. PRICE: $69.95 plus shipping and handling. ISBN: 1580400191. Summary: This chapter on the exercise prescription is from a book that provides a practical, comprehensive guide to diabetes and exercise for health care professionals involved in patient care. To optimize the likelihood of a safe and effective response, the exercise prescription should take into consideration safety aspects as well as the mode, frequency, duration, intensity, rate of progression, and timing of physical activity. The foremost priority in compiling the exercise prescription is to minimize the potential adverse effects of exercise via appropriate screening, program design, monitoring, and patient education. Before embarking on an exercise program, all people with diabetes should undergo a complete medical history and physical examination aimed at the identification of macrovascular, microvascular, and neurological complications. A continuing care plan with follow up medical evaluations is also necessary. An exercise electrocardiogram is recommended for individuals with one or more of the following: known or suspected coronary artery disease, type 1 diabetes of greater than 15 years' duration or type 2 diabetes of longer than 10 years duration, age older than 35 years, any additional risk factor for coronary artery disease, microvascular disease (proliferative retinopathy, a type of eye disease, or nephropathy, a type of kidney disease), peripheral vascular disease, or autonomic neuropathy (nerve disease). In the absence of an exercise electrocardiogram, light to moderate rather than vigorous exercise should be prescribed for these individuals. The type, frequency, duration and intensity of exercise training should be modulated to achieve an energy expenditure of 700 to 2,000 calories per week. Generally, to accomplish the desired weekly energy expenditure, aerobic exercise should be performed for 20 to 60 minutes, 3 to 5 days a week, at an intensity corresponding to 55 to 79 percent of maximum heart rate. Exercise training should begin at a comfortable intensity and gradually progress in accordance with baseline cardiorespiratory fitness level, age, weight, health status, personal preferences, and individual goals. Exercise participation should be timed so that it does not coincide with periods of peak insulin absorption. And specific steps should be taken to enhance compliance with exercise training. 7 tables. 24 references.

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CHAPTER

7.

PERIODICALS AND ELECTROCARDIOGRAM

NEWS

ON

Overview In this chapter, we suggest a number of news sources and present various periodicals that cover electrocardiogram.

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

Gender gap in electrocardiogram rate: study Source: Reuters Health eLine Date: December 26, 2001

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

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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 “electrocardiogram” (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 electrocardiogram: •

Atherosclerosis and Coronary Artery Disease in SLE Source: Lupus News. 20(2): 6-7. Spring 2000. Contact: Available from Lupus Foundation of America. 1300 Piccard Drive, Suite 200, Rockville, MD 20850-4303. (800) 558-0121 or (301) 670-9292. Fax (301) 670-9486. Website: www.lupus.org/lupus. Summary: This newsletter article provides health professionals and people who have systemic lupus erythematosus (SLE) with information on atherosclerosis and coronary artery disease in SLE. Accelerated atherosclerosis has become recognized as one of the causes of illness and death in people with SLE. The prevalence of coronary artery disease in lupus varies, and deaths from atherosclerosis tend to occur in older people who have had lupus for longer periods of time. Although mortality rates from atherosclerosis appear low, people who have lupus and atherosclerosis are usually younger than the typical person with atherosclerosis. Routine tests such as stress testing and electrocardiograms used to detect early coronary artery disease may be unreliable in people who have lupus, and some people may not be able to undergo the exercise necessary to complete the tests properly. Known risk factors for coronary disease in the general population, including hypertension, diabetes, and lipid disorders, may be magnified in people who have lupus. These factors, and older age and postmenopausal status, are linked with coronary artery disease in people who have lupus. SLE itself also appears to be a risk factor for coronary disease. Awareness of the issue of lupus related coronary artery disease by both the physician and patient is important.

Academic Periodicals covering Electrocardiogram Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to electrocardiogram. In addition to these sources, you can search for articles covering electrocardiogram 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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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 Institute10: •

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

10

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

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•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

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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.11 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:12 •

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

11

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

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•

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

•

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

The NLM Gateway13 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.14 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “electrocardiogram” (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 124332 2480 447 100 229 127588

HSTAT15 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.16 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.17 Simply search by “electrocardiogram” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

13

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

14

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 15 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 16 17

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

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

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Coffee Break: Tutorials for Biologists18 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.19 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.20 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

18 Adapted 19

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

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 20 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on electrocardiogram can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internetbased 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 electrocardiogram. 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 electrocardiogram. 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 “electrocardiogram”:

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Other guides Cardiomyopathy http://www.nlm.nih.gov/medlineplus/cardiomyopathy.html Congenital Heart Disease http://www.nlm.nih.gov/medlineplus/congenitalheartdisease.html Diagnostic Imaging http://www.nlm.nih.gov/medlineplus/diagnosticimaging.html Heart Attack http://www.nlm.nih.gov/medlineplus/heartattack.html Heart Diseases http://www.nlm.nih.gov/medlineplus/heartdiseases.html Heart Failure http://www.nlm.nih.gov/medlineplus/heartfailure.html Heart Valve Diseases http://www.nlm.nih.gov/medlineplus/heartvalvediseases.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 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 “electrocardiogram” (or synonyms). The following was recently posted: •

Guidelines for the interpretation of the neonatal electrocardiogram Source: European Society of Cardiology - Medical Specialty Society; 2002 September; 16 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3425&nbr=2651&a mp;string=electrocardiogram 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 electrocardiogram. 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

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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 electrocardiogram. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with electrocardiogram. 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 electrocardiogram. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “electrocardiogram” (or a synonym), and you will receive information on all relevant organizations listed in the database.

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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 “electrocardiogram”. 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 “electrocardiogram” (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 “electrocardiogram” (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.21

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

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

21

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

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

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

•

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

•

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

•

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

•

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

•

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

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

22

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

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•

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Finding Medical Libraries

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

•

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

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

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

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

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

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

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

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

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

•

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

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

•

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

139

ELECTROCARDIOGRAM DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. 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] Abducens: A striated, extrinsic muscle of the eyeball that originates from the annulus of Zinn. [NIH] Aberrant: Wandering or deviating from the usual or normal course. [EU] Ablate: In surgery, is to remove. [NIH] Ablation: The removal of an organ by surgery. [NIH] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Acetylcholinesterase: An enzyme that catalyzes the hydrolysis of acetylcholine to choline and acetate. In the CNS, this enzyme plays a role in the function of peripheral neuromuscular junctions. EC 3.1.1.7. [NIH] 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] Actin: Essential component of the cell skeleton. [NIH] Action Potentials: The electric response of a nerve or muscle to its stimulation. [NIH] Acuity: Clarity or clearness, especially of the vision. [EU] Acute myeloid leukemia: AML. A quickly progressing disease in which too many immature blood-forming cells are found in the blood and bone marrow. Also called acute myelogenous leukemia or acute nonlymphocytic leukemia. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerobic: In biochemistry, reactions that need oxygen to happen or happen when oxygen is present. [NIH]

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Aerobic Exercise: A type of physical activity that includes walking, jogging, running, and dancing. Aerobic training improves the efficiency of the aerobic energy-producing systems that can improve cardiorespiratory endurance. [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] 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] Agoraphobia: Obsessive, persistent, intense fear of open places. [NIH] Airway: A device for securing unobstructed passage of air into and out of the lungs during general anesthesia. [NIH] Albumin: 1. Any protein that is soluble in water and moderately concentrated salt solutions and is coagulable by heat. 2. Serum albumin; the major plasma protein (approximately 60 per cent of the total), which is responsible for much of the plasma colloidal osmotic pressure and serves as a transport protein carrying large organic anions, such as fatty acids, bilirubin, and many drugs, and also carrying certain hormones, such as cortisol and thyroxine, when their specific binding globulins are saturated. Albumin is synthesized in the liver. Low serum levels occur in protein malnutrition, active inflammation and serious hepatic and renal disease. [EU] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Alleles: Mutually exclusive forms of the same gene, occupying the same locus on homologous chromosomes, and governing the same biochemical and developmental process. [NIH] Alpha Particles: Positively charged particles composed of two protons and two neutrons, i.e., helium nuclei, emitted during disintegration of very heavy isotopes; a beam of alpha particles or an alpha ray has very strong ionizing power, but weak penetrability. [NIH] Alternans: Ipsilateral abducens palsy and facial paralysis and contralateral hemiplegia of the limbs, due to a nuclear or infranuclear lesion in the pons. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH]

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Ameliorating: A changeable condition which prevents the consequence of a failure or accident from becoming as bad as it otherwise would. [NIH] Amino acid: Any organic compound containing an amino (-NH2 and a carboxyl (- COOH) group. The 20 a-amino acids listed in the accompanying table are the amino acids from which proteins are synthesized by formation of peptide bonds during ribosomal translation 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] Amnestic: Nominal aphasia; a difficulty in finding the right name for an object. [NIH] Ampulla: A sac-like enlargement of a canal or duct. [NIH] 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] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Anesthetics: Agents that are capable of inducing a total or partial loss of sensation, especially tactile sensation and pain. They may act to induce general anesthesia, in which an unconscious state is achieved, or may act locally to induce numbness or lack of sensation at a targeted site. [NIH] Angina: Chest pain that originates in the heart. [NIH] Angina Pectoris: The symptom of paroxysmal pain consequent to myocardial ischemia usually of distinctive character, location and radiation, and provoked by a transient stressful situation during which the oxygen requirements of the myocardium exceed the capacity of the coronary circulation to supply it. [NIH] Angiogram: An x-ray of blood vessels; the person receives an injection of dye to outline the vessels on the x-ray. [NIH] Angiography: Radiography of blood vessels after injection of a contrast medium. [NIH] Angioplasty: Endovascular reconstruction of an artery, which may include the removal of atheromatous plaque and/or the endothelial lining as well as simple dilatation. These are procedures performed by catheterization. When reconstruction of an artery is performed surgically, it is called endarterectomy. [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] Ankle: That part of the lower limb directly above the foot. [NIH]

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Anomalies: Birth defects; abnormalities. [NIH] Antiarrhythmic: An agent that prevents or alleviates cardiac arrhythmia. [EU] 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]

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] Antidepressant: A drug used to treat depression. [NIH] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antineoplastic: Inhibiting or preventing the development of neoplasms, checking the maturation and proliferation of malignant cells. [EU] Antineoplastic Agents: Substances that inhibit or prevent the proliferation of neoplasms. [NIH]

Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Aorta: The main trunk of the systemic arteries. [NIH] Apnea: A transient absence of spontaneous respiration. [NIH] Apnoea: Cessation of breathing. [EU] Approximate: Approximal [EU] Aqueous: Having to do with water. [NIH] Arginine: An essential amino acid that is physiologically active in the L-form. [NIH] Arrhythmia: Any variation from the normal rhythm or rate of the heart beat. [NIH] Arrhythmogenic: Producing or promoting arrhythmia. [EU] Arrhythmogenic Right Ventricular Dysplasia: A weakening of the right ventricle that results in the back up of blood in the venous system, liver, gastrointestinal tract, and extremities. [NIH] 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] Arteriosus: Circle composed of anastomosing arteries derived from two long posterior ciliary and seven anterior ciliary arteries, located in the ciliary body about the root of the iris. [NIH]

Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH]

Dictionary 143

Artifacts: Any visible result of a procedure which is caused by the procedure itself and not by the entity being analyzed. Common examples include histological structures introduced by tissue processing, radiographic images of structures that are not naturally present in living tissue, and products of chemical reactions that occur during analysis. [NIH] Asymptomatic: Having no signs or symptoms of disease. [NIH] Asynchronous: Pacing mode where only one timing interval exists, that between the stimuli. While the duration of this interval may be varied, it is not modified by any sensed event once set. As no sensing occurs, the upper and lower rate intervals are the same as the pacema. [NIH] Asystole: Cardiac standstill or arrest; absence of a heartbeat; called also Beau's syndrome. [EU]

Atrial: Pertaining to an atrium. [EU] Atrial Fibrillation: Disorder of cardiac rhythm characterized by rapid, irregular atrial impulses and ineffective atrial contractions. [NIH] Atrial Flutter: Rapid, irregular atrial contractions due to an abnormality of atrial excitation. [NIH]

Atrioventricular: Pertaining to an atrium of the heart and to a ventricle. [EU] Atrioventricular Node: A small nodular mass of specialized muscle fibers located in the interatrial septum near the opening of the coronary sinus. It gives rise to the atrioventricular bundle of the conduction system of the heart. [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] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Audiometry: The testing of the acuity of the sense of hearing to determine the thresholds of the lowest intensity levels at which an individual can hear a set of tones. The frequencies between 125 and 8000 Hz are used to test air conduction thresholds, and the frequencies between 250 and 4000 Hz are used to test bone conduction thresholds. [NIH] Autodigestion: Autolysis; a condition found in disease of the stomach: the stomach wall is digested by the gastric juice. [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] 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]

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Axillary: Pertaining to the armpit area, including the lymph nodes that are located there. [NIH]

Axillary Vein: The venous trunk of the upper limb; a continuation of the basilar and brachial veins running from the lower border of the teres major muscle to the outer border of the first rib where it becomes the subclavian vein. [NIH] Axons: Nerve fibers that are capable of rapidly conducting impulses away from the neuron cell body. [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] 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] Bacteriuria: The presence of bacteria in the urine with or without consequent urinary tract infection. Since bacteriuria is a clinical entity, the term does not preclude the use of urine/microbiology for technical discussions on the isolation and segregation of bacteria in the urine. [NIH] 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] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bile Acids: Acids made by the liver that work with bile to break down fats. [NIH] Biliary: Having to do with the liver, bile ducts, and/or gallbladder. [NIH] Biliary Tract: The gallbladder and its ducts. [NIH] Bilirubin: A bile pigment that is a degradation product of heme. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] 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]

Dictionary 145

Biphasic: Having two phases; having both a sporophytic and a gametophytic phase in the life cycle. [EU] Bladder: The organ that stores urine. [NIH] Bloating: Fullness or swelling in the abdomen that often occurs after meals. [NIH] Blood Glucose: Glucose in blood. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood urea: A waste product in the blood that comes from the breakdown of food protein. The kidneys filter blood to remove urea. As kidney function decreases, the BUN level increases. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Body Mass Index: One of the anthropometric measures of body mass; it has the highest correlation with skinfold thickness or body density. [NIH] Bone Conduction: Sound transmission through the bones of the skull to the inner ear. [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] 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] Bradycardia: Excessive slowness in the action of the heart, usually with a heart rate below 60 beats per minute. [NIH] Bradykinin: A nonapeptide messenger that is enzymatically produced from kallidin in the blood where it is a potent but short-lived agent of arteriolar dilation and increased capillary permeability. Bradykinin is also released from mast cells during asthma attacks, from gut walls as a gastrointestinal vasodilator, from damaged tissues as a pain signal, and may be a neurotransmitter. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

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] Buccal: Pertaining to or directed toward the cheek. In dental anatomy, used to refer to the buccal surface of a tooth. [EU] Bupropion: A unicyclic, aminoketone antidepressant. The mechanism of its therapeutic actions is not well understood, but it does appear to block dopamine uptake. The hydrochloride is available as an aid to smoking cessation treatment. [NIH] Bypass: A surgical procedure in which the doctor creates a new pathway for the flow of

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body fluids. [NIH] Calcification: Deposits of calcium in the tissues of the breast. Calcification in the breast can be seen on a mammogram, but cannot be detected by touch. There are two types of breast calcification, macrocalcification and microcalcification. Macrocalcifications are large deposits and are usually not related to cancer. Microcalcifications are specks of calcium that may be found in an area of rapidly dividing cells. Many microcalcifications clustered together may be a sign of cancer. [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] Cannula: A tube for insertion into a duct or cavity; during insertion its lumen is usually occupied by a trocar. [EU] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Carcinogenic: Producing carcinoma. [EU] Cardiac: Having to do with the heart. [NIH] Cardiac arrest: A sudden stop of heart function. [NIH] Cardiac catheterization: A procedure in which a thin, hollow tube is inserted into a blood vessel. The tube is then advanced through the vessel into the heart, enabling a physician to study the heart and its pumping activity. [NIH] Cardiac Output: The volume of blood passing through the heart per unit of time. It is usually expressed as liters (volume) per minute so as not to be confused with stroke volume (volume per beat). [NIH] Cardiograph: An instrument for recording the heart action in respect of rate and amplitude of beat. [NIH] Cardiology: The study of the heart, its physiology, and its functions. [NIH] Cardiomegaly: Hypertrophy or enlargement of the heart. [NIH] Cardiomyopathy: A general diagnostic term designating primary myocardial disease, often of obscure or unknown etiology. [EU] Cardiopulmonary: Having to do with the heart and lungs. [NIH] Cardiopulmonary Bypass: Diversion of the flow of blood from the entrance of the right atrium directly to the aorta (or femoral artery) via an oxygenator thus bypassing both the heart and lungs. [NIH] Cardiopulmonary Resuscitation: The artificial substitution of heart and lung action as indicated for heart arrest resulting from electric shock, drowning, respiratory arrest, or other causes. The two major components of cardiopulmonary resuscitation are artificial ventilation and closed-chest cardiac massage. [NIH] Cardiorespiratory: Relating to the heart and lungs and their function. [EU]

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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] Cardioversion: Electrical reversion of cardiac arrhythmias to normal sinus rhythm, formerly using alternatic current, but now employing direct current. [NIH] Carotid Arteries: Either of the two principal arteries on both sides of the neck that supply blood to the head and neck; each divides into two branches, the internal carotid artery and the external carotid artery. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Case series: A group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information (for example, age, gender, ethnic origin) and information on diagnosis, treatment, response to treatment, and follow-up after treatment. [NIH] Castration: Surgical removal or artificial destruction of gonads. [NIH] Catecholamines: A general class of ortho-dihydroxyphenylalkylamines derived from tyrosine. [NIH] Catheter: A flexible tube used to deliver fluids into or withdraw fluids from the body. [NIH] Catheter Ablation: Removal of tissue with electrical current delivered via electrodes positioned at the distal end of a catheter. Energy sources are commonly direct current (DCshock) or alternating current at radiofrequencies (usually 750 kHz). The technique is used most often to ablate the AV junction and/or accessory pathways in order to interrupt AV conduction and produce AV block in the treatment of various tachyarrhythmias. [NIH] Catheterization: Use or insertion of a tubular device into a duct, blood vessel, hollow organ, or body cavity for injecting or withdrawing fluids for diagnostic or therapeutic purposes. It differs from intubation in that the tube here is used to restore or maintain patency in obstructions. [NIH] 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] 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 membrane: Cell membrane = plasma membrane. The structure enveloping a cell, enclosing the cytoplasm, and forming a selective permeability barrier; it consists of lipids,

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proteins, and some carbohydrates, the lipids thought to form a bilayer in which integral proteins are embedded to varying degrees. [EU] Cell Respiration: The metabolic process of all living cells (animal and plant) in which oxygen is used to provide a source of energy for the cell. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Central Nervous System Infections: Pathogenic infections of the brain, spinal cord, and meninges. DNA virus infections; RNA virus infections; bacterial infections; mycoplasma infections; Spirochaetales infections; fungal infections; protozoan infections; helminthiasis; and prion diseases may involve the central nervous system as a primary or secondary process. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] 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] Chaperonins: A class of sequence-related molecular chaperones found in bacteria, mitochondria, and plastids. Chaperonins are abundant constitutive proteins that increase in amount after stresses such as heat shock, bacterial infection of macrophages, and an increase in the cellular content of unfolded proteins. Bacterial chaperonins are major immunogens in human bacterial infections because of their accumulation during the stress of infection. Two members of this class of chaperones are chaperonin 10 and chaperonin 60. [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] Checkup: A general physical examination. [NIH] Chelation: Combination with a metal in complexes in which the metal is part of a ring. [EU] Chelation Therapy: Therapy of heavy metal poisoning using agents which sequester the metal from organs or tissues and bind it firmly within the ring structure of a new compound which can be eliminated from the body. [NIH] Chemokines: Class of pro-inflammatory cytokines that have the ability to attract and activate leukocytes. They can be divided into at least three structural branches: C (chemokines, C), CC (chemokines, CC), and CXC (chemokines, CXC), according to variations in a shared cysteine motif. [NIH] Chemotherapeutic agent: A drug used to treat cancer. [NIH] Chest Pain: Pressure, burning, or numbness in the chest. [NIH] Chest wall: The ribs and muscles, bones, and joints that make up the area of the body between the neck and the abdomen. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Choline: A basic constituent of lecithin that is found in many plants and animal organs. It is important as a precursor of acetylcholine, as a methyl donor in various metabolic processes, and in lipid metabolism. [NIH] Chromosomal: Pertaining to chromosomes. [EU] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH]

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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] Circadian: Repeated more or less daily, i. e. on a 23- to 25-hour cycle. [NIH] Circulatory system: The system that contains the heart and the blood vessels and moves blood throughout the body. This system helps tissues get enough oxygen and nutrients, and it helps them get rid of waste products. The lymph system, which connects with the blood system, is often considered part of the circulatory system. [NIH] Cirrhosis: A type of chronic, progressive liver disease. [NIH] Clamp: A u-shaped steel rod used with a pin or wire for skeletal traction in the treatment of certain fractures. [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] Clonic: Pertaining to or of the nature of clonus. [EU] 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] Cochlea: The part of the internal ear that is concerned with hearing. It forms the anterior part of the labyrinth, is conical, and is placed almost horizontally anterior to the vestibule. [NIH]

Cochlear: Of or pertaining to the cochlea. [EU] 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] 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

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classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Compliance: Distensibility measure of a chamber such as the lungs (lung compliance) or bladder. Compliance is expressed as a change in volume per unit change in pressure. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] 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] Computer Systems: Systems composed of a computer or computers, peripheral equipment, such as disks, printers, and terminals, and telecommunications capabilities. [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] Concomitant: Accompanying; accessory; joined with another. [EU] Conduction: The transfer of sound waves, heat, nervous impulses, or electricity. [EU] Confounding: Extraneous variables resulting in outcome effects that obscure or exaggerate the "true" effect of an intervention. [NIH] Congestive heart failure: Weakness of the heart muscle that leads to a buildup of fluid in body tissues. [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] Connexins: A group of homologous proteins which form the intermembrane channels of gap junctions. The connexins are the products of an identified gene family which has both highly conserved and highly divergent regions. The variety contributes to the wide range of

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functional properties of gap junctions. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Constriction: The act of constricting. [NIH] Consumption: Pulmonary tuberculosis. [NIH] Contractility: Capacity for becoming short in response to a suitable stimulus. [EU] Contracture: A condition of fixed high resistance to passive stretch of a muscle, resulting from fibrosis of the tissues supporting the muscles or the joints, or from disorders of the muscle fibres. [EU] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Contralateral: Having to do with the opposite side of the body. [NIH] Contrast medium: A substance that is introduced into or around a structure and, because of the difference in absorption of x-rays by the contrast medium and the surrounding tissues, allows radiographic visualization of the structure. [EU] 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] Conus: A large, circular, white patch around the optic disk due to the exposing of the sclera as a result of degenerative change or congenital abnormality in the choroid and retina. [NIH] Conventional therapy: A currently accepted and widely used treatment for a certain type of disease, based on the results of past research. Also called conventional treatment. [NIH] Conventional treatment: A currently accepted and widely used treatment for a certain type of disease, based on the results of past research. Also called conventional therapy. [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] Convulsive: Relating or referring to spasm; affected with spasm; characterized by a spasm or spasms. [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 Angiography: Radiography of the vascular system of the heart muscle after injection of a contrast medium. [NIH] Coronary Arteriosclerosis: Thickening and loss of elasticity of the coronary arteries. [NIH] Coronary Artery Bypass: Surgical therapy of ischemic coronary artery disease achieved by grafting a section of saphenous vein, internal mammary artery, or other substitute between the aorta and the obstructed coronary artery distal to the obstructive lesion. [NIH] Coronary Circulation: The circulation of blood through the coronary vessels of the heart. [NIH]

Coronary Disease: Disorder of cardiac function due to an imbalance between myocardial function and the capacity of the coronary vessels to supply sufficient flow for normal function. It is a form of myocardial ischemia (insufficient blood supply to the heart muscle)

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caused by a decreased capacity of the coronary vessels. [NIH] Coronary heart disease: A type of heart disease caused by narrowing of the coronary arteries that feed the heart, which needs a constant supply of oxygen and nutrients carried by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by fat and cholesterol deposits and cannot supply enough blood to the heart, CHD results. [NIH] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Coronary Vessels: The veins and arteries of the heart. [NIH] Corpus: The body of the uterus. [NIH] Corpus Luteum: The yellow glandular mass formed in the ovary by an ovarian follicle that has ruptured and discharged its ovum. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cortical: Pertaining to or of the nature of a cortex or bark. [EU] Cortisol: A steroid hormone secreted by the adrenal cortex as part of the body's response to stress. [NIH] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Craniocerebral Trauma: Traumatic injuries involving the cranium and intracranial structures (i.e., brain; cranial nerves; meninges; and other structures). Injuries may be classified by whether or not the skull is penetrated (i.e., penetrating vs. nonpenetrating) or whether there is an associated hemorrhage. [NIH] Creatinine: A compound that is excreted from the body in urine. Creatinine levels are measured to monitor kidney function. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cutaneous: Having to do with the skin. [NIH] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cytokines: Non-antibody proteins secreted by inflammatory leukocytes and some nonleukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or cell types rather than by specialized glands. They generally act locally in a paracrine or autocrine rather than endocrine manner. [NIH] 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] 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] Data Display: The visual display of data in a man-machine system. An example is a cathode ray tube display in which certain data can be called for from the computer and presented on the screen. [NIH] Decompensation: Failure of compensation; cardiac decompensation is marked by dyspnea, venous engorgement, and edema. [EU] Defibrillation: The act to arrest the fibrillation of (heart muscle) by applying electric shock

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across the chest, thus depolarizing the heart cells and allowing normal rhythm to return. [EU] 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] 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] Dendritic: 1. Branched like a tree. 2. Pertaining to or possessing dendrites. [EU] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [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] Deprivation: Loss or absence of parts, organs, powers, or things that are needed. [EU] Dermal: Pertaining to or coming from the skin. [NIH] Diabetes Insipidus: A metabolic disorder due to disorders in the production or release of vasopressin. It is characterized by the chronic excretion of large amounts of low specific gravity urine and great thirst. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diabetic Ketoacidosis: Complication of diabetes resulting from severe insulin deficiency coupled with an absolute or relative increase in glucagon concentration. The metabolic acidosis is caused by the breakdown of adipose stores and resulting increased levels of free fatty acids. Glucagon accelerates the oxidation of the free fatty acids producing excess ketone bodies (ketosis). [NIH] Diagnostic Equipment: Nonexpendable items used in examinination. [NIH] Diagnostic Errors: Incorrect diagnoses after clinical examination or technical diagnostic procedures. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Dialyzer: A part of the hemodialysis machine. (See hemodialysis under dialysis.) The dialyzer has two sections separated by a membrane. One section holds dialysate. The other holds the patient's blood. [NIH] Diaphragm: The musculofibrous partition that separates the thoracic cavity from the abdominal cavity. Contraction of the diaphragm increases the volume of the thoracic cavity aiding inspiration. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diastole: Period of relaxation of the heart, especially the ventricles. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Diastolic blood pressure: The minimum pressure that remains within the artery when the heart is at rest. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive tract: The organs through which food passes when food is eaten. These organs are the mouth, esophagus, stomach, small and large intestines, and rectum. [NIH]

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Dilatation: The act of dilating. [NIH] Dilate: Relax; expand. [NIH] Dilated cardiomyopathy: Heart muscle disease that leads to enlargement of the heart's chambers, robbing the heart of its pumping ability. [NIH] Dipyridamole: A drug that prevents blood cell clumping and enhances the effectiveness of fluorouracil and other chemotherapeutic agents. [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] Discriminant Analysis: A statistical analytic technique used with discrete dependent variables, concerned with separating sets of observed values and allocating new values. It is sometimes used instead of regression analysis. [NIH] Dissociation: 1. The act of separating or state of being separated. 2. The separation of a molecule into two or more fragments (atoms, molecules, ions, or free radicals) produced by the absorption of light or thermal energy or by solvation. 3. In psychology, a defense mechanism in which a group of mental processes are segregated from the rest of a person's mental activity in order to avoid emotional distress, as in the dissociative disorders (q.v.), or in which an idea or object is segregated from its emotional significance; in the first sense it is roughly equivalent to splitting, in the second, to isolation. 4. A defect of mental integration in which one or more groups of mental processes become separated off from normal consciousness and, thus separated, function as a unitary whole. [EU] 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] Dopamine: An endogenous catecholamine and prominent neurotransmitter in several systems of the brain. In the synthesis of catecholamines from tyrosine, it is the immediate precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. A family of dopaminergic receptor subtypes mediate its action. Dopamine is used pharmacologically for its direct (beta adrenergic agonist) and indirect (adrenergic releasing) sympathomimetic effects including its actions as an inotropic agent and as a renal vasodilator. [NIH] Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] 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] 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]

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Duct: A tube through which body fluids pass. [NIH] Duodenum: The first part of the small intestine. [NIH] Dyspepsia: Impaired digestion, especially after eating. [NIH] Dyspnea: Difficult or labored breathing. [NIH] Echocardiography: Ultrasonic recording of the size, motion, and composition of the heart and surrounding tissues. The standard approach is transthoracic. [NIH] Ectopic: Pertaining to or characterized by ectopia. [EU] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [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] Elastic: Susceptible of resisting and recovering from stretching, compression or distortion applied by a force. [EU] Electric shock: A dangerous patho-physiological effect resulting from an electric current passing through the body of a human or animal. [NIH] Electrocardiogram: Measurement of electrical activity during heartbeats. [NIH] Electrocardiograph: Apparatus which, by means of currents produced by contractions of the cardiac muscle, records heart movements as electro-cardiograms. [NIH] Electrocardiography: Recording of the moment-to-moment electromotive forces of the heart as projected onto various sites on the body's surface, delineated as a scalar function of time. [NIH]

Electrode: Component of the pacing system which is at the distal end of the lead. It is the interface with living cardiac tissue across which the stimulus is transmitted. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electrophysiological: Pertaining to electrophysiology, that is a branch of physiology that is concerned with the electric phenomena associated with living bodies and involved in their functional activity. [EU] Electroshock: Induction of a stress reaction in experimental subjects by means of an electrical shock; applies to either convulsive or non-convulsive states. [NIH] Embolus: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Emergency Medical Technicians: Paramedical personnel trained to provide basic emergency care and life support under the supervision of physicians and/or nurses. These services may be carried out at the site of the emergency, in the ambulance, or in a health care institution. [NIH] Empirical: A treatment based on an assumed diagnosis, prior to receiving confirmatory laboratory test results. [NIH] Encephalopathy: A disorder of the brain that can be caused by disease, injury, drugs, or chemicals. [NIH] Endarterectomy:

Surgical

excision,

performed

under

general

anesthesia,

of

the

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atheromatous tunica intima of an artery. When reconstruction of an artery is performed as an endovascular procedure through a catheter, it is called atherectomy. [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] Endoscope: A thin, lighted tube used to look at tissues inside the body. [NIH] Endoscopic: A technique where a lateral-view endoscope is passed orally to the duodenum for visualization of the ampulla of Vater. [NIH] Endoscopy: Endoscopic examination, therapy or surgery performed on interior parts of the body. [NIH] Endothelium: A layer of epithelium that lines the heart, blood vessels (endothelium, vascular), lymph vessels (endothelium, lymphatic), and the serous cavities of the body. [NIH] Endothelium-derived: Small molecule that diffuses to the adjacent muscle layer and relaxes it. [NIH] 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]

Enzyme: A protein that speeds up chemical reactions in the body. [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] Epidural: The space between the wall of the spinal canal and the covering of the spinal cord. An epidural injection is given into this space. [NIH] Epilepticus: Repeated and prolonged epileptic seizures without recovery of consciousness between attacks. [NIH] Erection: The condition of being made rigid and elevated; as erectile tissue when filled with blood. [EU] Escalation: Progressive use of more harmful drugs. [NIH] Esophageal: Having to do with the esophagus, the muscular tube through which food passes from the throat to the stomach. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Estrogen: One of the two female sex hormones. [NIH] Ether: One of a class of organic compounds in which any two organic radicals are attached directly to a single oxygen atom. [NIH] Evacuation: An emptying, as of the bowels. [EU] Evoke: The electric response recorded from the cerebral cortex after stimulation of a peripheral sense organ. [NIH] Excitability: Property of a cardiac cell whereby, when the cell is depolarized to a critical level (called threshold), the membrane becomes permeable and a regenerative inward current causes an action potential. [NIH] Excitation: An act of irritation or stimulation or of responding to a stimulus; the addition of

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energy, as the excitation of a molecule by absorption of photons. [EU] Excitatory: When cortical neurons are excited, their output increases and each new input they receive while they are still excited raises their output markedly. [NIH] Excitatory Amino Acid Agonists: Drugs that bind to and activate excitatory amino acid receptors. [NIH] Exercise Test: Controlled physical activity, more strenuous than at rest, which is performed in order to allow assessment of physiological functions, particularly cardiovascular and pulmonary, but also aerobic capacity. Maximal (most intense) exercise is usually required but submaximal exercise is also used. The intensity of exercise is often graded, using criteria such as rate of work done, oxygen consumption, and heart rate. Physiological data obtained from an exercise test may be used for diagnosis, prognosis, and evaluation of disease severity, and to evaluate therapy. Data may also be used in prescribing exercise by determining a person's exercise capacity. [NIH] Exhaustion: The feeling of weariness of mind and body. [NIH] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Expiration: The act of breathing out, or expelling air from the lungs. [EU] Extracellular: Outside a cell or cells. [EU] Facial: Of or pertaining to the face. [EU] Facial Paralysis: Severe or complete loss of facial muscle motor function. This condition may result from central or peripheral lesions. Damage to CNS motor pathways from the cerebral cortex to the facial nuclei in the pons leads to facial weakness that generally spares the forehead muscles. Facial nerve diseases generally results in generalized hemifacial weakness. Neuromuscular junction diseases and muscular diseases may also cause facial paralysis or paresis. [NIH] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Family Practice: A medical specialty concerned with the provision of continuing, comprehensive primary health care for the entire family. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]

Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] 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] Femoral: Pertaining to the femur, or to the thigh. [EU] Femoral Artery: The main artery of the thigh, a continuation of the external iliac artery. [NIH] Fetal Monitoring: Physiologic or biochemical monitoring of the fetus. It is usually done during labor and may be performed in conjunction with the monitoring of uterine activity. It may also be performed prenatally as when the mother is undergoing surgery. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibrillation: A small, local, involuntary contraction of muscle, invisible under the skin, resulting from spontaneous activation of single muscle cells or muscle fibres. [EU] Fibrin: A protein derived from fibrinogen in the presence of thrombin, which forms part of

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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] Fibrinolytic: Pertaining to, characterized by, or causing the dissolution of fibrin by enzymatic action [EU] Fibrinolytic Agents: Fibrinolysin or agents that convert plasminogen to fibrinolysin (plasmin). [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Flatulence: Production or presence of gas in the gastrointestinal tract which may be expelled through the anus. [NIH] Flatus: Gas passed through the rectum. [NIH] Fluorescence: The property of emitting radiation while being irradiated. The radiation emitted is usually of longer wavelength than that incident or absorbed, e.g., a substance can be irradiated with invisible radiation and emit visible light. X-ray fluorescence is used in diagnosis. [NIH] Fluorouracil: A pyrimidine analog that acts as an antineoplastic antimetabolite and also has immunosuppressant. It interferes with DNA synthesis by blocking the thymidylate synthetase conversion of deoxyuridylic acid to thymidylic acid. [NIH] Flurothyl: A convulsant primarily used in experimental animals. It was formerly used to induce convulsions as a alternative to electroshock therapy. [NIH] Flutter: A rapid vibration or pulsation. [EU] Fluvoxamine: A selective serotonin reuptake inhibitor. It is effective in the treatment of depression, obsessive-compulsive disorders, anxiety, panic disorders, and alcohol amnestic disorders. [NIH] Fold: A plication or doubling of various parts of the body. [NIH] Forearm: The part between the elbow and the wrist. [NIH] 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] Gas exchange: Primary function of the lungs; transfer of oxygen from inhaled air into the blood and of carbon dioxide from the blood into the lungs. [NIH] Gastric: Having to do with the stomach. [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid.

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[NIH]

Gastroesophageal Reflux: Reflux of gastric juice and/or duodenal contents (bile acids, pancreatic juice) into the distal esophagus, commonly due to incompetence of the lower esophageal sphincter. Gastric regurgitation is an extension of this process with entry of fluid into the pharynx or mouth. [NIH] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] 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]

Generator: Any system incorporating a fixed parent radionuclide from which is produced a daughter radionuclide which is to be removed by elution or by any other method and used in a radiopharmaceutical. [NIH] Genetic Counseling: Advising families of the risks involved pertaining to birth defects, in order that they may make an informed decision on current or future pregnancies. [NIH] Genital: Pertaining to the genitalia. [EU] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] 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] Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Goats: Any of numerous agile, hollow-horned ruminants of the genus Capra, closely related to the sheep. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [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] Grafting: The operation of transfer of tissue from one site to another. [NIH] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH]

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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] 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] Headache Disorders: Common conditions characterized by persistent or recurrent headaches. Headache syndrome classification systems may be based on etiology (e.g., vascular headache, post-traumatic headaches, etc.), temporal pattern (e.g., cluster headache, paroxysmal hemicrania, etc.), and precipitating factors (e.g., cough headache). [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 Arrest: Sudden and usually momentary cessation of the heart beat. This sudden cessation may, but not usually, lead to death, sudden, cardiac. [NIH] Heart attack: A seizure of weak or abnormal functioning of the heart. [NIH] Heart Catheterization: Procedure which includes placement of catheter, recording of intracardiac and intravascular pressure, obtaining blood samples for chemical analysis, and cardiac output measurement, etc. Specific angiographic injection techniques are also involved. [NIH] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH] Heart Sounds: The sounds heard over the cardiac region produced by the functioning of the heart. There are four distinct sounds: the first occurs at the beginning of systole and is heard as a "lubb" sound; the second is produced by the closing of the aortic and pulmonary valves and is heard as a "dupp" sound; the third is produced by vibrations of the ventricular walls when suddenly distended by the rush of blood from the atria; and the fourth is produced by atrial contraction and ventricular filling but is rarely audible in the normal heart. The physiological concept of heart sounds is differentiated from the pathological heart murmurs. [NIH]

Heartbeat: One complete contraction of the heart. [NIH] Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Heat-Shock Proteins: Proteins which are synthesized in eukaryotic organisms and bacteria in response to hyperthermia and other environmental stresses. They increase thermal tolerance and perform functions essential to cell survival under these conditions. [NIH] Heat-Shock Proteins 90: A class of molecular chaperones whose members act in the mechanism of signal transduction by steroid receptors. [NIH] Hemiplegia: Severe or complete loss of motor function on one side of the body. This condition is usually caused by BRAIN DISEASES that are localized to the cerebral hemisphere opposite to the side of weakness. Less frequently, BRAIN STEM lesions; cervical spinal cord diseases; peripheral nervous system diseases; and other conditions may manifest as hemiplegia. The term hemiparesis (see paresis) refers to mild to moderate weakness

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involving one side of the body. [NIH] Hemochromatosis: A disease that occurs when the body absorbs too much iron. The body stores the excess iron in the liver, pancreas, and other organs. May cause cirrhosis of the liver. Also called iron overload disease. [NIH] Hemodialysis: The use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid. The cleaned blood then flows through another set of tubes back into the body. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemolytic: A disease that affects the blood and blood vessels. It destroys red blood cells, cells that cause the blood to clot, and the lining of blood vessels. HUS is often caused by the Escherichia coli bacterium in contaminated food. People with HUS may develop acute renal failure. [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] 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] 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]

Heterozygote: An individual having different alleles at one or more loci in homologous chromosome segments. [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] Homozygote: An individual in which both alleles at a given locus are identical. [NIH] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hormone Replacement Therapy: Therapeutic use of hormones to alleviate the effects of hormone deficiency. [NIH] Human Engineering: The science of designing, building or equipping mechanical devices or artificial environments to the anthropometric, physiological, or psychological requirements of the people who will use them. [NIH]

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Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrolysis: The process of cleaving a chemical compound by the addition of a molecule of water. [NIH] Hyperglycemia: Abnormally high blood sugar. [NIH] Hypericum: Genus of perennial plants in the family Clusiaceae (Hypericaceae). Herbal and homeopathic preparations are used for depression, neuralgias, and a variety of other conditions. Contains flavonoids, glycosides, mucilage, tannins, and volatile oils (oils, essential). [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hyperthyroidism: Excessive functional activity of the thyroid gland. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Hypoglycemia: Abnormally low blood sugar [NIH] Hypotension: Abnormally low blood pressure. [NIH] 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] Hysterectomy: Excision of the uterus. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Idiopathic: Describes a disease of unknown cause. [NIH] Imipramine: The prototypical tricyclic antidepressant. It has been used in major depression, dysthymia, bipolar depression, attention-deficit disorders, agoraphobia, and panic disorders. It has less sedative effect than some other members of this therapeutic group. [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] Immunology: The study of the body's immune system. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] In situ: In the natural or normal place; confined to the site of origin without invasion of neighbouring tissues. [EU] 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]

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Incompetence: Physical or mental inadequacy or insufficiency. [EU] 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] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Information Systems: Integrated set of files, procedures, and equipment for the storage, manipulation, and retrieval of information. [NIH] Informed Consent: Voluntary authorization, given to the physician by the patient, with full comprehension of the risks involved, for diagnostic or investigative procedures and medical and surgical treatment. [NIH] Infuse: To pour (a liquid) into something. [EU] Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] Infusion Pumps: Fluid propulsion systems driven mechanically, electrically, or osmotically that are used to inject (or infuse) over time agents into a patient or experimental animal; used routinely in hospitals to maintain a patent intravenous line, to administer antineoplastic agents and other drugs in thromboembolism, heart disease, diabetes mellitus (insulin infusion systems is also available), and other disorders. [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] Initiator: A chemically reactive substance which may cause cell changes if ingested, inhaled or absorbed into the body; the substance may thus initiate a carcinogenic process. [NIH] Inlay: In dentistry, a filling first made to correspond with the form of a dental cavity and then cemented into the cavity. [NIH] Inorganic: Pertaining to substances not of organic origin. [EU] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of

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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 Infusion Systems: Portable or implantable devices for infusion of insulin. Includes open-loop systems which may be patient-operated or controlled by a pre-set program and are designed for constant delivery of small quantities of insulin, increased during food ingestion, and closed-loop systems which deliver quantities of insulin automatically based on an electronic glucose sensor. [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] Intensive Care: Advanced and highly specialized care provided to medical or surgical patients whose conditions are life-threatening and require comprehensive care and constant monitoring. It is usually administered in specially equipped units of a health care facility. [NIH]

Interindividual: Occurring between two or more individuals. [EU] Interleukin-1: A soluble factor produced by monocytes, macrophages, and other cells which activates T-lymphocytes and potentiates their response to mitogens or antigens. IL-1 consists of two distinct forms, IL-1 alpha and IL-1 beta which perform the same functions but are distinct proteins. The biological effects of IL-1 include the ability to replace macrophage requirements for T-cell activation. The factor is distinct from interleukin-2. [NIH] Interleukin-2: Chemical mediator produced by activated T lymphocytes and which regulates the proliferation of T cells, as well as playing a role in the regulation of NK cell activity. [NIH] Intestinal: Having to do with the intestines. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intracellular: Inside a cell. [NIH] Intraocular: Within the eye. [EU] Intraocular pressure: Pressure of the fluid inside the eye; normal IOP varies among individuals. [NIH] Intravascular: Within a vessel or vessels. [EU] Intravenous: IV. Into a vein. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] 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] 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] 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] Ionizing: Radiation comprising charged particles, e. g. electrons, protons, alpha-particles, etc., having sufficient kinetic energy to produce ionization by collision. [NIH]

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Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Ischemic stroke: A condition in which the blood supply to part of the brain is cut off. Also called "plug-type" strokes. Blocked arteries starve areas of the brain controlling sight, speech, sensation, and movement so that these functions are partially or completely lost. Ischemic stroke is the most common type of stroke, accounting for 80 percent of all strokes. Most ischemic strokes are caused by a blood clot called a thrombus, which blocks blood flow in the arteries feeding the brain, usually the carotid artery in the neck, the major vessel bringing blood to the brain. When it becomes blocked, the risk of stroke is very high. [NIH] Isoelectric: Separation of amphoteric substances, dissolved in water, based on their isoelectric behavior. The amphoteric substances are a mixture of proteins to be separated and of auxiliary "carrier ampholytes". [NIH] Isoelectric Point: The pH in solutions of proteins and related compounds at which the dipolar ions are at a maximum. [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] Ketone Bodies: Chemicals that the body makes when there is not enough insulin in the blood and it must break down fat for its energy. Ketone bodies can poison and even kill body cells. When the body does not have the help of insulin, the ketones build up in the blood and then "spill" over into the urine so that the body can get rid of them. The body can also rid itself of one type of ketone, called acetone, through the lungs. This gives the breath a fruity odor. Ketones that build up in the body for a long time lead to serious illness and coma. [NIH] Ketosis: A condition of having ketone bodies build up in body tissues and fluids. The signs of ketosis are nausea, vomiting, and stomach pain. Ketosis can lead to ketoacidosis. [NIH] Kidney Disease: Any one of several chronic conditions that are caused by damage to the cells of the kidney. People who have had diabetes for a long time may have kidney damage. Also called nephropathy. [NIH] Kinetic: Pertaining to or producing motion. [EU] 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] Lethal: Deadly, fatal. [EU] Leukemia: Cancer of blood-forming tissue. [NIH] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH]

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Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Licensed practical nurse: One skilled in the care of the sick, but who has not graduated from a regular nursing school or passed an examination to qualify as a graduate nurse. [NIH] Life cycle: The successive stages through which an organism passes from fertilized ovum or spore to the fertilized ovum or spore of the next generation. [NIH] Ligaments: Shiny, flexible bands of fibrous tissue connecting together articular extremities of bones. They are pliant, tough, and inextensile. [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] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Locomotor: Of or pertaining to locomotion; pertaining to or affecting the locomotive apparatus of the body. [EU] 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] Lower Esophageal Sphincter: The muscle between the esophagus and stomach. When a person swallows, this muscle relaxes to let food pass from the esophagus to the stomach. It stays closed at other times to keep stomach contents from flowing back into the esophagus. [NIH]

Lumen: The cavity or channel within a tube or tubular organ. [EU] Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [NIH] 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] Lymphocytes: White blood cells formed in the body's lymphoid tissue. The nucleus is round or ovoid with coarse, irregularly clumped chromatin while the cytoplasm is typically pale blue with azurophilic (if any) granules. Most lymphocytes can be classified as either T or B (with subpopulations of each); those with characteristics of neither major class are called null cells. [NIH] 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] 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,

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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] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]

Mammary: Pertaining to the mamma, or breast. [EU] Mammogram: An x-ray of the breast. [NIH] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] 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] Menopause: Permanent cessation of menstruation. [NIH] Menstrual Cycle: The period of the regularly recurring physiologic changes in the endometrium occurring during the reproductive period in human females and some primates and culminating in partial sloughing of the endometrium (menstruation). [NIH] Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Mental 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] 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] Microcalcifications: Tiny deposits of calcium in the breast that cannot be felt but can be detected on a mammogram. A cluster of these very small specks of calcium may indicate that cancer is present. [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]

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Microspheres: Small uniformly-sized spherical particles frequently radioisotopes or various reagents acting as tags or markers. [NIH]

labeled

with

Mobility: Capability of movement, of being moved, or of flowing freely. [EU] Modeling: A treatment procedure whereby the therapist presents the target behavior which the learner is to imitate and make part of his repertoire. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecular Chaperones: A family of cellular proteins that mediate the correct assembly or disassembly of other polypeptides, and in some cases their assembly into oligomeric structures, but which are not components of those final structures. It is believed that chaperone proteins assist polypeptides to self-assemble by inhibiting alternative assembly pathways that produce nonfunctional structures. Some classes of molecular chaperones are the nucleoplasmins, the chaperonins, the heat-shock proteins 70, and the heat-shock proteins 90. [NIH] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] 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] 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] 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] Motor Activity: The physical activity of an organism as a behavioral phenomenon. [NIH] Mucosa: A mucous membrane, or tunica mucosa. [EU] 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 Fibers: Large single cells, either cylindrical or prismatic in shape, that form the basic unit of muscle tissue. They consist of a soft contractile substance enclosed in a tubular sheath. [NIH] 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] Myocardial Ischemia: A disorder of cardiac function caused by insufficient blood flow to the muscle tissue of the heart. The decreased blood flow may be due to narrowing of the coronary arteries (coronary arteriosclerosis), to obstruction by a thrombus (coronary thrombosis), or less commonly, to diffuse narrowing of arterioles and other small vessels within the heart. Severe interruption of the blood supply to the myocardial tissue may result

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in necrosis of cardiac muscle (myocardial infarction). [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Myosin: Chief protein in muscle and the main constituent of the thick filaments of muscle fibers. In conjunction with actin, it is responsible for the contraction and relaxation of muscles. [NIH] Myotonic Dystrophy: A condition presenting muscle weakness and wasting which may be progressive. [NIH] Naloxone: A specific opiate antagonist that has no agonist activity. It is a competitive antagonist at mu, delta, and kappa opioid receptors. [NIH] Naltrexone: Derivative of noroxymorphone that is the N-cyclopropylmethyl congener of naloxone. It is a narcotic antagonist that is effective orally, longer lasting and more potent than naloxone, and has been proposed for the treatment of heroin addiction. The FDA has approved naltrexone for the treatment of alcohol dependence. [NIH] Narcotic: 1. Pertaining to or producing narcosis. 2. An agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] 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] Nephrologist: A doctor who treats patients with kidney problems or hypertension. [NIH] Nephropathy: Disease of the kidneys. [EU] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] 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] 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] Neurophysiology: The scientific discipline concerned with the physiology of the nervous system. [NIH] Neurotoxicity: The tendency of some treatments to cause damage to the nervous system. [NIH]

Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins,

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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] 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] Nitroprusside: (OC-6-22)-Pentakis(cyano-C)nitrosoferrate(2-). A powerful vasodilator used in emergencies to lower blood pressure or to improve cardiac function. It is also an indicator for free sulfhydryl groups in proteins. [NIH] Normal Distribution: Continuous frequency distribution of infinite range. Its properties are as follows: 1) continuous, symmetrical distribution with both tails extending to infinity; 2) arithmetic mean, mode, and median identical; and 3) shape completely determined by the mean and standard deviation. [NIH] Normotensive: 1. Characterized by normal tone, tension, or pressure, as by normal blood pressure. 2. A person with normal blood pressure. [EU] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Obsessive-Compulsive Disorder: An anxiety disorder characterized by recurrent, persistent obsessions or compulsions. Obsessions are the intrusive ideas, thoughts, or images that are experienced as senseless or repugnant. Compulsions are repetitive and seemingly purposeful behavior which the individual generally recognizes as senseless and from which the individual does not derive pleasure although it may provide a release from tension. [NIH] On-line: A sexually-reproducing population derived from a common parentage. [NIH] Oophorectomy: Surgery to remove one or both ovaries. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH] Opiate: A remedy containing or derived from opium; also any drug that induces sleep. [EU] Opium: The air-dried exudate from the unripe seed capsule of the opium poppy, Papaver

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somniferum, or its variant, P. album. It contains a number of alkaloids, but only a few morphine, codeine, and papaverine - have clinical significance. Opium has been used as an analgesic, antitussive, antidiarrheal, and antispasmodic. [NIH] Orchiectomy: The surgical removal of one or both testicles. [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] 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] 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] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [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] Ovum: A female germ cell extruded from the ovary at ovulation. [NIH] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]

Oximetry: The determination of oxygen-hemoglobin saturation of blood either by withdrawing a sample and passing it through a classical photoelectric oximeter or by electrodes attached to some translucent part of the body like finger, earlobe, or skin fold. It includes non-invasive oxygen monitoring by pulse oximetry. [NIH] Oxygen Consumption: The oxygen consumption is determined by calculating the difference between the amount of oxygen inhaled and exhaled. [NIH] Oxygenator: An apparatus by which oxygen is introduced into the blood during circulation outside the body, as during open heart surgery. [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] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Palsy: Disease of the peripheral nervous system occurring usually after many years of increased lead absorption. [NIH] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH]

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Pancreatic: Having to do with the pancreas. [NIH] Pancreatic Juice: The fluid containing digestive enzymes secreted by the pancreas in response to food in the duodenum. [NIH] Pancreatitis: Acute or chronic inflammation of the pancreas, which may be asymptomatic or symptomatic, and which is due to autodigestion of a pancreatic tissue by its own enzymes. It is caused most often by alcoholism or biliary tract disease; less commonly it may be associated with hyperlipaemia, hyperparathyroidism, abdominal trauma (accidental or operative injury), vasculitis, or uraemia. [EU] Panic: A state of extreme acute, intense anxiety and unreasoning fear accompanied by disorganization of personality function. [NIH] Panic Disorder: A type of anxiety disorder characterized by unexpected panic attacks that last minutes or, rarely, hours. Panic attacks begin with intense apprehension, fear or terror and, often, a feeling of impending doom. Symptoms experienced during a panic attack include dyspnea or sensations of being smothered; dizziness, loss of balance or faintness; choking sensations; palpitations or accelerated heart rate; shakiness; sweating; nausea or other form of abdominal distress; depersonalization or derealization; paresthesias; hot flashes or chills; chest discomfort or pain; fear of dying and fear of not being in control of oneself or going crazy. Agoraphobia may also develop. Similar to other anxiety disorders, it may be inherited as an autosomal dominant trait. [NIH] Papilla: A small nipple-shaped elevation. [NIH] Papillary: Pertaining to or resembling papilla, or nipple. [EU] Paroxysmal: Recurring in paroxysms (= spasms or seizures). [EU] Patch: A piece of material used to cover or protect a wound, an injured part, etc.: a patch over the eye. [NIH] Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathologies: The study of abnormality, especially the study of diseases. [NIH] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] Perennial: Lasting through the year of for several years. [EU] Perfusion: Bathing an organ or tissue with a fluid. In regional perfusion, a specific area of the body (usually an arm or a leg) receives high doses of anticancer drugs through a blood vessel. Such a procedure is performed to treat cancer that has not spread. [NIH] Pericarditis: Inflammation of the pericardium. [EU] Pericardium: The fibroserous sac surrounding the heart and the roots of the great vessels. [NIH]

Perioperative: Around the time of surgery; usually lasts from the time of going into the hospital or doctor's office for surgery until the time the patient goes home. [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

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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] Perirhinal: Transitional region between the older and newer cortex. [NIH] Perspiration: Sweating; the functional secretion of sweat. [EU] 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] 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] 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] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physical Fitness: A state of well-being in which performance is optimal, often as a result of physical conditioning which may be prescribed for disease therapy. [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] Piloerection: Involuntary erection or bristling of hairs. [NIH] Pilot study: The initial study examining a new method or treatment. [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] Plague: An acute infectious disease caused by Yersinia pestis that affects humans, wild rodents, and their ectoparasites. This condition persists due to its firm entrenchment in sylvatic rodent-flea ecosystems throughout the world. Bubonic plague is the most common form. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plaque: A clear zone in a bacterial culture grown on an agar plate caused by localized destruction of bacterial cells by a bacteriophage. The concentration of infective virus in a

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fluid can be estimated by applying the fluid to a culture and counting the number of. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma protein: One of the hundreds of different proteins present in blood plasma, including carrier proteins ( such albumin, transferrin, and haptoglobin), fibrinogen and other coagulation factors, complement components, immunoglobulins, enzyme inhibitors, precursors of substances such as angiotension and bradykinin, and many other types of proteins. [EU] Plasmin: A product of the lysis of plasminogen (profibrinolysin) by plasminogen activators. It is composed of two polypeptide chains, light (B) and heavy (A), with a molecular weight of 75,000. It is the major proteolytic enzyme involved in blood clot retraction or the lysis of fibrin and quickly inactivated by antiplasmins. EC 3.4.21.7. [NIH] Plasminogen: Precursor of fibrinolysin (plasmin). It is a single-chain beta-globulin of molecular weight 80-90,000 found mostly in association with fibrinogen in plasma; plasminogen activators change it to fibrinolysin. It is used in wound debriding and has been investigated as a thrombolytic agent. [NIH] Plasminogen Activator Inhibitor 1: A member of the serpin family of proteins. It inhibits both the tissue-type and urokinase-type plasminogen activators. [NIH] Plasminogen Activators: A heterogeneous group of proteolytic enzymes that convert plasminogen to plasmin. They are concentrated in the lysosomes of most cells and in the vascular endothelium, particularly in the vessels of the microcirculation. EC 3.4.21.-. [NIH] 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]

Plethysmography: Recording of change in the size of a part as modified by the circulation in it. [NIH] Pneumonia: Inflammation of the lungs. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polydipsia: Chronic excessive thirst, as in diabetes mellitus or diabetes insipidus. [EU] Polyphagia: Great hunger; a sign of diabetes. People with this great hunger often lose weight. [NIH] Polyuria: Urination of a large volume of urine with an increase in urinary frequency, commonly seen in diabetes. [NIH] Pons: The part of the central nervous system lying between the medulla oblongata and the mesencephalon, ventral to the cerebellum, and consisting of a pars dorsalis and a pars ventralis. [NIH] Port: An implanted device through which blood may be withdrawn and drugs may be infused without repeated needle sticks. Also called a port-a-cath. [NIH]

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Port-a-cath: An implanted device through which blood may be withdrawn and drugs may be infused without repeated needle sticks. Also called a port. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postmenopausal: Refers to the time after menopause. Menopause is the time in a woman's life when menstrual periods stop permanently; also called "change of life." [NIH] Postoperative: After surgery. [NIH] 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] Potentiates: A degree of synergism which causes the exposure of the organism to a harmful substance to worsen a disease already contracted. [NIH] Power Sources: Devices that supply energy. [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] Precipitating Factors: Factors associated with the definitive onset of a disease, illness, accident, behavioral response, or course of action. Usually one factor is more important or more obviously recognizable than others, if several are involved, and one may often be regarded as "necessary". Examples include exposure to specific disease; amount or level of an infectious organism, drug, or noxious agent, etc. [NIH] Precordial: Pertaining to the precordium (= region over the heart and lower part of the thorax). [EU] Preoperative: Preceding an operation. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Primary endpoint: The main result that is measured at the end of a study to see if a given treatment worked (e.g., the number of deaths or the difference in survival between the treatment group and the control group). What the primary endpoint will be is decided before the study begins. [NIH] Primary Prevention: Prevention of disease or mental disorders in susceptible individuals or populations through promotion of health, including mental health, and specific protection, as in immunization, as distinguished from the prevention of complications or after-effects of existing disease. [NIH] Prion: Small proteinaceous infectious particles that resist inactivation by procedures modifying nucleic acids and contain an abnormal isoform of a cellular protein which is a major and necessary component. [NIH] 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]

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Programmed Instruction: Instruction in which learners progress at their own rate using workbooks, textbooks, or electromechanical devices that provide information in discrete steps, test learning at each step, and provide immediate feedback about achievement. (ERIC, Thesaurus of ERIC Descriptors, 1996). [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Projection: A defense mechanism, operating unconsciously, whereby that which is emotionally unacceptable in the self is rejected and attributed (projected) to others. [NIH] Proliferative Retinopathy: A disease of the small blood vessels of the retina of the eye. [NIH] Promyelocytic leukemia: A type of acute myeloid leukemia, a quickly progressing disease in which too many immature blood-forming cells are found in the blood and bone marrow. [NIH]

Prone: Having the front portion of the body downwards. [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] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] 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] 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] Pruritus: An intense itching sensation that produces the urge to rub or scratch the skin to obtain relief. [NIH] Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Public Health: Branch of medicine concerned with the prevention and control of disease

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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 Circulation: The circulation of blood through the lungs. [NIH] Pulmonary Valve: A valve situated at the entrance to the pulmonary trunk from the right ventricle. [NIH] Pulsation: A throb or rhythmical beat, as of the heart. [EU] 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]

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] Quinidine: An optical isomer of quinine, extracted from the bark of the Cinchona tree and similar plant species. This alkaloid dampens the excitability of cardiac and skeletal muscles by blocking sodium and potassium currents across cellular membranes. It prolongs cellular action potential, and decreases automaticity. Quinidine also blocks muscarinic and alphaadrenergic neurotransmission. [NIH] Quinine: An alkaloid derived from the bark of the cinchona tree. It is used as an antimalarial drug, and is the active ingredient in extracts of the cinchona that have been used for that purpose since before 1633. Quinine is also a mild antipyretic and analgesic and has been used in common cold preparations for that purpose. It was used commonly and as a bitter and flavoring agent, and is still useful for the treatment of babesiosis. Quinine is also useful in some muscular disorders, especially nocturnal leg cramps and myotonia congenita, because of its direct effects on muscle membrane and sodium channels. The mechanisms of its antimalarial effects are not well understood. [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] Radioactive: Giving off radiation. [NIH] Radiological: Pertaining to radiodiagnostic and radiotherapeutic procedures, and interventional radiology or other planning and guiding medical radiology. [NIH] Radiopharmaceutical: Any medicinal product which, when ready for use, contains one or more radionuclides (radioactive isotopes) included for a medicinal purpose. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Reentry: Reexcitation caused by continuous propagation of the same impulse for one or more cycles. [NIH]

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Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reflux: The term used when liquid backs up into the esophagus from the stomach. [NIH] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Refractory: Not readily yielding to treatment. [EU] 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] Reliability: Used technically, in a statistical sense, of consistency of a test with itself, i. e. the extent to which we can assume that it will yield the same result if repeated a second time. [NIH]

Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Research Design: A plan for collecting and utilizing data so that desired information can be obtained with sufficient precision or so that an hypothesis can be tested properly. [NIH] 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] Respirators: These enable the wearer to breathe in atmospheres polluted by dust, poisonous vapors, smoke, etc., and are therefore used in certain industries or in warfare; they consist essentially of a mask, a metal frame with outlet and inlet valves, and a socket. [NIH] Restoration: Broad term applied to any inlay, crown, bridge or complete denture which restores or replaces loss of teeth or oral tissues. [NIH] Resuscitation: The restoration to life or consciousness of one apparently dead; it includes such measures as artificial respiration and cardiac massage. [EU] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Retinopathy: 1. Retinitis (= inflammation of the retina). 2. Retinosis (= degenerative, noninflammatory condition of the retina). [EU] Retrograde: 1. Moving backward or against the usual direction of flow. 2. Degenerating, deteriorating, or catabolic. [EU]

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Reversion: A return to the original condition, e. g. the reappearance of the normal or wild type in previously mutated cells, tissues, or organisms. [NIH] 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] Saphenous: Applied to certain structures in the leg, e. g. nerve vein. [NIH] Saphenous Vein: The vein which drains the foot and leg. [NIH] Scrapie: A fatal disease of the nervous system in sheep and goats, characterized by pruritus, debility, and locomotor incoordination. It is caused by proteinaceous infectious particles called prions. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] 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] Sedative: 1. Allaying activity and excitement. 2. An agent that allays excitement. [EU] Sediment: A precipitate, especially one that is formed spontaneously. [EU] Segmental: Describing or pertaining to a structure which is repeated in similar form in successive segments of an organism, or which is undergoing segmentation. [NIH] Segmentation: The process by which muscles in the intestines move food and wastes through the body. [NIH] 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] Sensor: A device designed to respond to physical stimuli such as temperature, light, magnetism or movement and transmit resulting impulses for interpretation, recording, movement, or operating control. [NIH] Septal: An abscess occurring at the root of the tooth on the proximal surface. [NIH] Septum: A dividing wall or partition; a general term for such a structure. The term is often used alone to refer to the septal area or to the septum pellucidum. [EU] Septum Pellucidum: A triangular double membrane separating the anterior horns of the lateral ventricles of the brain. It is situated in the median plane and bounded by the corpus callosum and the body and columns of the fornix. [NIH] Sequencing: The determination of the order of nucleotides in a DNA or RNA chain. [NIH] Sequester: A portion of dead bone which has become detached from the healthy bone tissue, as occurs in necrosis. [NIH] Serine: A non-essential amino acid occurring in natural form as the L-isomer. It is synthesized from glycine or threonine. It is involved in the biosynthesis of purines, pyrimidines, and other amino acids. [NIH] Serology: The study of serum, especially of antigen-antibody reactions in vitro. [NIH] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the

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

Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Sinoatrial Node: The small mass of modified cardiac muscle fibers located at the junction of the superior vena cava and right atrium. Contraction impulses probably start in this node, spread over the atrium and are then transmitted by the atrioventricular bundle to the ventricle. [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] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Sleep apnea: A serious, potentially life-threatening breathing disorder characterized by repeated cessation of breathing due to either collapse of the upper airway during sleep or absence of respiratory effort. [NIH] Sleep Deprivation: The state of being deprived of sleep under experimental conditions, due to life events, or from a wide variety of pathophysiologic causes such as medication effect, chronic illness, psychiatric illness, or sleep disorder. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smoking Cessation: Discontinuation of the habit of smoking, the inhaling and exhaling of tobacco smoke. [NIH] Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Social Work: The use of community resources, individual case work, or group work to promote the adaptive capacities of individuals in relation to their social and economic environments. It includes social service agencies. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH]

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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] Sound wave: An alteration of properties of an elastic medium, such as pressure, particle displacement, or density, that propagates through the medium, or a superposition of such alterations. [NIH] 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] 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] Spike: The activation of synapses causes changes in the permeability of the dendritic membrane leading to changes in the membrane potential. This difference of the potential travels along the axon of the neuron and is called spike. [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] Sports Medicine: The field of medicine concerned with physical fitness and the diagnosis and treatment of injuries sustained in sports activities. [NIH] Standard therapy: A currently accepted and widely used treatment for a certain type of cancer, based on the results of past research. [NIH] Status Epilepticus: Repeated and prolonged epileptic seizures without recovery of consciousness between attacks. [NIH] Steel: A tough, malleable, iron-based alloy containing up to, but no more than, two percent carbon and often other metals. It is used in medicine and dentistry in implants and instrumentation. [NIH] Stenosis: Narrowing or stricture of a duct or canal. [EU] Stent: A device placed in a body structure (such as a blood vessel or the gastrointestinal

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tract) to provide support and keep the structure open. [NIH] Sterile: Unable to produce children. [NIH] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] 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] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stricture: The abnormal narrowing of a body opening. Also called stenosis. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subarachnoid: Situated or occurring between the arachnoid and the pia mater. [EU] Subclavian: The direct continuation of the axillary vein at the lateral border of the first rib. It passes medially to join the internal jugular vein and form the brachiocephalic vein on each side. [NIH] Subclavian Artery: Artery arising from the brachiocephalic trunk on the right side and from the arch of the aorta on the left side. It distributes to the neck, thoracic wall, spinal cord, brain, meninges, and upper limb. [NIH] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] 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] Suction: The removal of secretions, gas or fluid from hollow or tubular organs or cavities by means of a tube and a device that acts on negative pressure. [NIH] Sudden cardiac death: Cardiac arrest caused by an irregular heartbeat. [NIH] Sudden death: Cardiac arrest caused by an irregular heartbeat. The term "death" is somewhat misleading, because some patients survive. [NIH] Superior vena cava: Vein which returns blood from the head and neck, upper limbs, and thorax. It is formed by the union of the two brachiocephalic veins. [NIH] Supraventricular: Situated or occurring above the ventricles, especially in an atrium or

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atrioventricular node. [EU] Surgical castration: Surgical removal of the testicles (orchiectomy) or ovaries (oophorectomy) to stop the production of sex hormones. Decreasing the levels of hormones may stop the growth of certain cancers. [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] Sweat: The fluid excreted by the sweat glands. It consists of water containing sodium chloride, phosphate, urea, ammonia, and other waste products. [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] 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] Synchrony: The normal physiologic sequencing of atrial and ventricular activation and contraction. [NIH] 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] Systole: Period of contraction of the heart, especially of the ventricles. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Systolic blood pressure: The maximum pressure in the artery produced as the heart contracts and blood begins to flow. [NIH] Tachyarrhythmia: Tachycardia associated with an irregularity in the normal heart rhythm. [EU]

Tachycardia: Excessive rapidity in the action of the heart, usually with a heart rate above 100 beats per minute. [NIH] Telecommunications: Transmission of information over distances via electronic means. [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] Testicles: The two egg-shaped glands found inside the scrotum. They produce sperm and male hormones. Also called testes. [NIH] Testosterone: A hormone that promotes the development and maintenance of male sex characteristics. [NIH] Thalassemia: A group of hereditary hemolytic anemias in which there is decreased synthesis of one or more hemoglobin polypeptide chains. There are several genetic types

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with clinical pictures ranging from barely detectable hematologic abnormality to severe and fatal anemia. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thoracic: Having to do with the chest. [NIH] Thorax: A part of the trunk between the neck and the abdomen; the chest. [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] Thromboembolism: Obstruction of a vessel by a blood clot that has been transported from a distant site by the blood stream. [NIH] Thrombolytic: 1. Dissolving or splitting up a thrombus. 2. A thrombolytic agent. [EU] Thrombolytic Therapy: Use of infusions of fibrinolytic agents to destroy or dissolve thrombi in blood vessels or bypass grafts. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thrombus: An aggregation of blood factors, primarily platelets and fibrin with entrapment of cellular elements, frequently causing vascular obstruction at the point of its formation. Some authorities thus differentiate thrombus formation from simple coagulation or clot formation. [EU] 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] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] 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] Tissue Plasminogen Activator: A proteolytic enzyme in the serine protease family found in many tissues which converts plasminogen to plasmin. It has fibrin-binding activity and is immunologically different from urinary plasminogen activator. The primary sequence, composed of 527 amino acids, is identical in both the naturally occurring and synthetic proteases. EC 3.4.21.68. [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] Tone: 1. The normal degree of vigour and tension; in muscle, the resistance to passive elongation or stretch; tonus. 2. A particular quality of sound or of voice. 3. To make permanent, or to change, the colour of silver stain by chemical treatment, usually with a

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heavy metal. [EU] Tonic: 1. Producing and restoring the normal tone. 2. Characterized by continuous tension. 3. A term formerly used for a class of medicinal preparations believed to have the power of restoring normal tone to tissue. [EU] Tonometry: The standard to determine the fluid pressure inside the eye (intraocular pressure). [NIH] Torsion: A twisting or rotation of a bodily part or member on its axis. [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] Traction: The act of pulling. [NIH] Transcutaneous: Transdermal. [EU] 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] Transfusion: The infusion of components of blood or whole blood into the bloodstream. The blood may be donated from another person, or it may have been taken from the person earlier and stored until needed. [NIH] 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] Tricyclic: Containing three fused rings or closed chains in the molecular structure. [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] 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

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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] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [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] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Urinalysis: Examination of urine by chemical, physical, or microscopic means. Routine urinalysis usually includes performing chemical screening tests, determining specific gravity, observing any unusual color or odor, screening for bacteriuria, and examining the sediment microscopically. [NIH] Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary Plasminogen Activator: A proteolytic enzyme that converts plasminogen to plasmin where the preferential cleavage is between arginine and valine. It was isolated originally from human urine, but is found in most tissues of most vertebrates. EC 3.4.21.73. [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] Urokinase: A drug that dissolves blood clots or prevents them from forming. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] 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] Valves: Flap-like structures that control the direction of blood flow through the heart. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasculitis: Inflammation of a blood vessel. [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] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Ventilation: 1. In respiratory physiology, the process of exchange of air between the lungs

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and the ambient air. Pulmonary ventilation (usually measured in litres per minute) refers to the total exchange, whereas alveolar ventilation refers to the effective ventilation of the alveoli, in which gas exchange with the blood takes place. 2. In psychiatry, verbalization of one's emotional problems. [EU] 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] Ventricular fibrillation: Rapid, irregular quivering of the heart's ventricles, with no effective heartbeat. [NIH] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] 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] 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] 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]

189

INDEX A Abdominal, 5, 10, 21, 65, 75, 139, 153, 171, 172 Abdominal Pain, 5, 10, 139 Abducens, 139, 140 Aberrant, 14, 68, 139 Ablate, 139, 147 Ablation, 24, 34, 70, 139 Acetylcholine, 139, 148, 169, 170 Acetylcholinesterase, 9, 139 Acidity, 139, 173 Acidosis, 139, 153 Actin, 139, 168, 169, 185 Action Potentials, 19, 26, 139 Acuity, 139, 143 Acute myeloid leukemia, 139, 176 Adjustment, 88, 139 Adrenal Cortex, 139, 152, 175 Adrenergic, 139, 154, 177 Adverse Effect, 9, 21, 113, 139, 180 Aerobic, 113, 139, 140, 157 Aerobic Exercise, 113, 140 Affinity, 22, 140, 180 Age of Onset, 140, 185 Agonist, 140, 154, 165, 169 Agoraphobia, 140, 162, 172 Airway, 140, 180 Albumin, 4, 140, 174 Algorithms, 14, 42, 59, 86, 92, 101, 140, 144 Alkaloid, 140, 177 Alleles, 140, 161 Alpha Particles, 140, 177 Alternans, 14, 21, 26, 28, 91, 140 Alternative medicine, 116, 140 Ameliorating, 55, 141 Amino acid, 141, 142, 157, 165, 172, 176, 179, 182, 184, 186 Amnestic, 141, 158 Ampulla, 141, 156 Anaesthesia, 42, 141, 163 Anal, 94, 141, 154 Analog, 103, 141, 158 Anatomical, 141, 143, 162 Anemia, 141, 167, 184 Anesthesia, 140, 141, 155 Anesthetics, 60, 141 Angina, 6, 32, 43, 72, 80, 112, 141 Angina Pectoris, 6, 32, 141

Angiogram, 80, 112, 141 Angiography, 6, 141 Angioplasty, 80, 141 Animal model, 13, 141 Anions, 140, 141, 165 Ankle, 24, 141 Anomalies, 68, 142 Antiarrhythmic, 14, 24, 142 Antibacterial, 142, 181 Antibiotic, 142, 181 Antibody, 140, 142, 149, 152, 160, 161, 163, 179, 181 Antidepressant, 142, 145, 162 Antigen, 140, 142, 149, 161, 163, 179 Antineoplastic, 142, 158, 163 Antineoplastic Agents, 142, 163 Anus, 141, 142, 145, 158 Anxiety, 43, 142, 158, 170, 172 Aorta, 57, 98, 105, 142, 146, 151, 182, 187 Apnea, 15, 75, 142 Apnoea, 28, 142 Approximate, 70, 142 Aqueous, 142, 144, 152 Arginine, 142, 170, 186 Arrhythmia, 4, 22, 32, 43, 59, 70, 71, 72, 80, 83, 92, 93, 96, 98, 142 Arrhythmogenic, 34, 142 Arrhythmogenic Right Ventricular Dysplasia, 34, 142 Arterial, 10, 15, 16, 21, 30, 37, 42, 76, 105, 142, 162, 176, 183 Arteries, 17, 55, 72, 80, 142, 145, 147, 151, 152, 165, 167, 168 Arterioles, 142, 145, 168 Arteriosus, 142, 177 Artifacts, 65, 90, 143 Asymptomatic, 5, 25, 95, 143, 172 Asynchronous, 84, 143 Asystole, 54, 76, 100, 143 Atrial, 9, 13, 15, 29, 31, 33, 34, 64, 70, 71, 92, 107, 143, 160, 183 Atrial Fibrillation, 9, 15, 29, 31, 64, 70, 71, 92, 143 Atrial Flutter, 34, 64, 143 Atrioventricular, 42, 143, 180, 183 Atrioventricular Node, 143, 183 Atrium, 70, 96, 104, 143, 146, 180, 182, 187 Atrophy, 9, 143

190

Electrocardiogram

Attenuation, 5, 17, 106, 143 Atypical, 86, 143 Audiometry, 113, 143 Autodigestion, 143, 172 Autonomic, 4, 11, 42, 77, 113, 139, 143, 181, 183 Autonomic Nervous System, 11, 77, 143, 181, 183 Autonomic Neuropathy, 4, 113, 143 Axillary, 144, 182 Axillary Vein, 144, 182 Axons, 11, 144 B Bacteria, 142, 144, 148, 155, 157, 160, 167, 181, 185, 186 Bacteriophage, 144, 173, 185 Bacteriuria, 144, 186 Base, 75, 91, 99, 101, 144, 153, 165, 183, 186 Benign, 144, 160 Bile, 144, 158, 159, 166, 182 Bile Acids, 144, 159, 182 Biliary, 144, 172 Biliary Tract, 144, 172 Bilirubin, 140, 144 Biochemical, 18, 22, 23, 140, 144, 157, 179 Biopsy, 8, 144, 172 Biotechnology, 26, 27, 116, 123, 144 Biotransformation, 144 Biphasic, 5, 145 Bladder, 143, 145, 150, 186 Bloating, 145, 163 Blood Glucose, 4, 66, 145, 161, 164 Blood urea, 10, 145 Blood vessel, 79, 141, 145, 146, 147, 148, 149, 156, 161, 165, 172, 176, 180, 181, 182, 184, 186 Body Fluids, 145, 146, 155, 180 Body Mass Index, 23, 145 Bone Conduction, 143, 145 Bone Marrow, 139, 145, 162, 166, 168, 176 Bowel, 5, 86, 141, 145, 164 Bowel Movement, 86, 145 Bradycardia, 11, 55, 145 Bradykinin, 145, 170, 174 Branch, 13, 58, 89, 135, 145, 155, 172, 176, 181, 184 Breakdown, 145, 153, 158 Breeding, 86, 145 Buccal, 145, 166 Bupropion, 12, 145 Bypass, 19, 80, 105, 145, 184

C Calcification, 16, 146 Calcium, 146, 149, 167, 185 Cannula, 105, 146 Carbohydrate, 10, 146, 159 Carbon Dioxide, 76, 146, 158, 173, 178 Carcinogenic, 146, 163, 182 Cardiac arrest, 4, 28, 61, 71, 100, 146, 182 Cardiac catheterization, 6, 146 Cardiac Output, 146, 160 Cardiograph, 95, 146 Cardiology, 17, 20, 24, 26, 28, 29, 30, 31, 32, 34, 36, 37, 73, 91, 109, 111, 128, 146 Cardiomegaly, 4, 146 Cardiomyopathy, 13, 30, 128, 146 Cardiopulmonary, 9, 19, 56, 76, 80, 100, 146 Cardiopulmonary Bypass, 19, 76, 146 Cardiopulmonary Resuscitation, 56, 80, 100, 146 Cardiorespiratory, 113, 140, 146 Cardiovascular disease, 4, 8, 16, 18, 94, 104, 147 Cardiovascular System, 17, 18, 42, 95, 143, 147 Cardioversion, 31, 54, 71, 147 Carotid Arteries, 16, 57, 147 Case report, 147 Case series, 41, 147 Castration, 147 Catecholamines, 21, 147, 154 Catheter, 24, 70, 96, 105, 147, 156, 160, 164 Catheter Ablation, 24, 96, 147 Catheterization, 17, 24, 141, 147, 164 Cathode, 147, 152 Cations, 147, 165 Caudal, 147, 162, 175 Causal, 68, 147 Cause of Death, 4, 13, 55, 56, 72, 80, 104, 147 Cell membrane, 69, 147, 153, 158, 173 Cell Respiration, 148, 178 Central Nervous System, 21, 139, 143, 148, 158, 160, 174, 179 Central Nervous System Infections, 148, 160 Cerebral, 56, 148, 151, 156, 157, 160, 167 Cerebrovascular, 10, 147, 148 Cerebrum, 148 Chaperonins, 148, 168 Character, 141, 148, 153 Checkup, 77, 148

Index 191

Chelation, 14, 44, 148 Chelation Therapy, 14, 44, 148 Chemokines, 23, 148 Chemotherapeutic agent, 148, 154 Chest Pain, 20, 89, 97, 112, 148 Chest wall, 50, 51, 148 Cholesterol, 36, 144, 148, 152, 182 Choline, 139, 148 Chromosomal, 16, 113, 148 Chromosome, 148, 161, 166 Chronic, 11, 62, 68, 80, 149, 153, 163, 165, 172, 174, 180, 182, 183, 186 Chronic Disease, 62, 149 Circadian, 21, 149 Circulatory system, 107, 149 Cirrhosis, 149, 161 Clamp, 22, 149 Clinical trial, 8, 10, 12, 92, 123, 149, 151, 154, 176, 177 Clonic, 11, 149 Cloning, 144, 149 Coagulation, 146, 149, 161, 174, 184 Cochlea, 149 Cochlear, 113, 149 Collapse, 18, 145, 149, 180 Colloidal, 140, 149 Complement, 149, 150, 174 Complementary and alternative medicine, 41, 44, 150 Complementary medicine, 41, 150 Compliance, 18, 113, 150 Computational Biology, 123, 150 Computed tomography, 9, 49, 64, 90, 150 Computer Simulation, 17, 150 Computer Systems, 77, 84, 150 Computerized tomography, 113, 150 Concomitant, 10, 12, 150 Conduction, 13, 32, 34, 37, 42, 51, 96, 98, 111, 143, 147, 150 Confounding, 14, 150 Congestive heart failure, 15, 69, 94, 150 Connective Tissue, 145, 150, 158, 183 Connexins, 12, 150, 158 Consciousness, 151, 153, 154, 156, 178, 181 Constipation, 5, 151 Constriction, 151, 165 Consumption, 61, 151, 171 Contractility, 79, 151 Contracture, 19, 151 Contraindications, ii, 151 Contralateral, 140, 151 Contrast medium, 141, 151

Control group, 151, 175 Conus, 151, 177 Conventional therapy, 100, 151 Conventional treatment, 151 Convulsions, 11, 151, 158 Convulsive, 11, 151, 155 Coordination, 56, 81, 151 Coronary, 5, 6, 8, 15, 16, 17, 19, 25, 27, 29, 32, 33, 55, 57, 72, 76, 80, 89, 94, 97, 98, 104, 105, 113, 117, 141, 143, 147, 151, 152, 167, 168 Coronary Angiography, 6, 151 Coronary Arteriosclerosis, 151, 168 Coronary Artery Bypass, 80, 151 Coronary Circulation, 141, 151 Coronary Disease, 6, 89, 98, 117, 151 Coronary heart disease, 6, 25, 55, 72, 104, 147, 152 Coronary Thrombosis, 152, 167, 168 Coronary Vessels, 151, 152 Corpus, 152, 175, 179 Corpus Luteum, 152, 175 Cortex, 152, 156, 157, 173 Cortical, 152, 157, 179 Cortisol, 21, 140, 152 Cranial, 152, 160 Craniocerebral Trauma, 152, 160 Creatinine, 10, 152, 186 Curative, 152, 184 Cutaneous, 152, 166 Cyclic, 65, 152, 160, 170 Cytokines, 148, 152 Cytoplasm, 147, 152, 166, 168 D Data Collection, 65, 90, 152 Data Display, 88, 152 Decompensation, 23, 152 Defibrillation, 4, 56, 58, 59, 61, 71, 76, 80, 81, 93, 96, 100, 152 Degenerative, 151, 153, 178 Dehydration, 10, 153 Dementia, 8, 9, 153 Dendritic, 153, 181 Density, 75, 98, 145, 153, 170, 181 Depolarization, 49, 56, 63, 81, 88, 153 Deprivation, 21, 153 Dermal, 106, 153 Diabetes Insipidus, 153, 174 Diabetes Mellitus, 6, 7, 10, 153, 159, 161, 163, 174 Diabetic Ketoacidosis, 10, 153 Diagnostic Equipment, 79, 106, 153

192

Electrocardiogram

Diagnostic Errors, 9, 153 Diagnostic procedure, 8, 47, 116, 153 Dialyzer, 153, 161 Diaphragm, 105, 153 Diarrhea, 5, 153 Diastole, 57, 59, 105, 153 Diastolic, 4, 8, 15, 64, 104, 153, 162 Diastolic blood pressure, 4, 9, 153 Digestion, 144, 145, 153, 155, 163, 164, 166, 182 Digestive tract, 7, 143, 153, 180 Dilatation, 98, 141, 154 Dilate, 98, 154 Dilated cardiomyopathy, 32, 154 Dipyridamole, 6, 154 Direct, iii, 7, 94, 147, 154, 177, 178, 182, 183 Discrete, 94, 101, 154, 176 Discriminant Analysis, 20, 154 Dissociation, 140, 154 Distal, 105, 147, 151, 154, 155, 159, 176 Dopamine, 145, 154, 169 Dorsal, 154, 175 Double-blind, 12, 154 Drive, ii, vi, 35, 58, 84, 105, 117, 154 Drug Interactions, 154 Drug Tolerance, 154, 184 Duct, 141, 146, 147, 155, 181 Duodenum, 144, 155, 156, 172, 182 Dyspepsia, 155, 163 Dyspnea, 152, 155, 172 E Echocardiography, 8, 14, 15, 20, 155 Ectopic, 19, 96, 155 Edema, 44, 152, 155, 186 Efficacy, 9, 12, 94, 155 Elastic, 155, 181 Electric shock, 146, 152, 155 Electrocardiograph, 73, 155 Electrocardiography, 30, 48, 78, 84, 91, 110, 155 Electrode, 48, 49, 50, 51, 52, 53, 60, 61, 67, 69, 70, 74, 85, 88, 96, 99, 102, 106, 147, 155 Electrolyte, 10, 155, 175, 180, 186 Electrophysiological, 13, 70, 155 Electroshock, 155, 158 Embolus, 155, 163 Embryo, 155, 163 Emergency Medical Technicians, 89, 155 Empirical, 20, 155 Encephalopathy, 68, 155 Endarterectomy, 141, 155

Endemic, 156, 166 Endoscope, 79, 156 Endoscopic, 79, 156 Endoscopy, 79, 156 Endothelium, 156, 170, 174 Endothelium-derived, 156, 170 Environmental Exposure, 16, 156 Environmental Health, 122, 124, 156 Enzyme, 139, 156, 160, 174, 176, 182, 184, 186, 187 Epidemic, 68, 156 Epidemiological, 16, 156 Epidural, 21, 156 Epilepticus, 11, 156 Erection, 156, 173 Escalation, 9, 156 Esophageal, 112, 156 Esophagus, 7, 112, 153, 156, 159, 160, 166, 173, 178, 182 Estrogen, 37, 156 Ether, 22, 156 Evacuation, 151, 156 Evoke, 156, 182 Excitability, 156, 177 Excitation, 57, 104, 143, 156, 169 Excitatory, 157, 165 Excitatory Amino Acid Agonists, 157, 165 Exercise Test, 6, 85, 157 Exhaustion, 157, 166 Exogenous, 144, 157, 185 Expiration, 157, 178 Extracellular, 150, 157, 180 F Facial, 140, 157, 181 Facial Paralysis, 140, 157 Family Planning, 123, 157 Family Practice, 28, 157 Fat, 24, 145, 152, 155, 157, 165, 166, 180 Fatigue, 104, 157, 160 Fatty acids, 41, 140, 153, 157 Feces, 151, 157 Femoral, 146, 157 Femoral Artery, 146, 157 Fetal Monitoring, 31, 157 Fetus, 157, 173, 186 Fibrillation, 4, 13, 26, 55, 59, 64, 71, 93, 100, 152, 157 Fibrin, 157, 158, 174, 184 Fibrinogen, 24, 157, 158, 174, 184 Fibrinolytic, 158, 184 Fibrinolytic Agents, 158, 184 Fibrosis, 151, 158

Index 193

Flatulence, 5, 158 Flatus, 158 Fluorescence, 13, 158 Fluorouracil, 154, 158 Flurothyl, 11, 158 Flutter, 64, 158 Fluvoxamine, 12, 158 Fold, 158, 171 Forearm, 145, 158 G Gallbladder, 139, 144, 158 Ganglia, 139, 158, 169, 183 Gap Junctions, 150, 158 Gas, 11, 67, 76, 105, 146, 158, 162, 163, 170, 182, 187 Gas exchange, 76, 158, 187 Gastric, 7, 112, 143, 158, 159, 160 Gastrin, 158, 161 Gastroesophageal Reflux, 7, 112, 159 Gastrointestinal, 5, 142, 145, 158, 159, 167, 179, 181, 182 Gastrointestinal tract, 142, 158, 159, 179, 182 Gene, 22, 54, 68, 112, 140, 144, 150, 159 Generator, 55, 58, 62, 67, 69, 159 Genetic Counseling, 112, 159 Genital, 143, 159 Gland, 139, 159, 171, 179, 182, 184 Glucose, 6, 10, 23, 66, 81, 82, 145, 153, 159, 161, 163, 164 Glucose Intolerance, 153, 159 Glucose tolerance, 6, 23, 159 Glucose Tolerance Test, 159 Glycoprotein, 158, 159 Goats, 159, 179 Governing Board, 159, 175 Grade, 92, 159 Grafting, 80, 151, 159 Growth, 8, 16, 23, 142, 159, 171, 173, 183, 184 Guanylate Cyclase, 160, 170 H Haptens, 140, 160 Headache, 5, 160 Headache Disorders, 160 Health Status, 106, 113, 160 Heart Arrest, 146, 160 Heart attack, 4, 28, 55, 72, 77, 97, 147, 160 Heart Catheterization, 95, 160 Heart failure, 25, 62, 77, 80, 98, 160 Heart Sounds, 60, 160

Heartbeat, 60, 96, 104, 105, 143, 160, 182, 187 Heartburn, 7, 97, 112, 160, 163 Heat-Shock Proteins, 160, 168 Heat-Shock Proteins 90, 160, 168 Hemiplegia, 140, 160 Hemochromatosis, 13, 161 Hemodialysis, 4, 153, 161 Hemoglobin, 6, 141, 161, 171, 183 Hemolytic, 161, 183 Hemorrhage, 25, 152, 160, 161, 182 Hemostasis, 76, 161, 179 Hepatic, 140, 159, 161 Hereditary, 13, 161, 183 Heredity, 159, 161 Heterogeneity, 140, 161 Heterozygote, 13, 161 Homologous, 140, 150, 161 Homozygote, 13, 161 Hormonal, 143, 161 Hormone, 17, 21, 36, 152, 158, 161, 163, 175, 183, 184 Hormone Replacement Therapy, 17, 36, 161 Human Engineering, 104, 161 Hydrogen, 139, 144, 146, 162, 168, 170, 171, 173, 176 Hydrolysis, 139, 144, 162, 176 Hyperglycemia, 8, 10, 23, 162 Hypericum, 37, 42, 162 Hypertension, 4, 8, 15, 25, 30, 31, 75, 117, 147, 160, 162, 169, 186 Hyperthyroidism, 98, 162 Hypertrophy, 4, 30, 51, 98, 146, 162 Hypoglycemia, 36, 162 Hypotension, 151, 162 Hypothalamus, 143, 162 Hysterectomy, 21, 162 I Id, 38, 43, 128, 129, 134, 136, 162 Idiopathic, 32, 162 Imipramine, 37, 42, 162 Immunity, 106, 162 Immunization, 162, 175 Immunology, 140, 162 Impairment, 9, 112, 162, 167 In situ, 18, 162 In vitro, 17, 162, 179, 184 In vivo, 17, 162 Incision, 162, 164 Incompetence, 159, 163

194

Electrocardiogram

Indicative, 49, 62, 82, 92, 100, 102, 104, 109, 163, 172, 186 Indigestion, 97, 112, 163 Induction, 13, 23, 26, 155, 163 Infarction, 14, 20, 28, 44, 55, 72, 83, 89, 97, 111, 163 Infection, 10, 66, 144, 148, 163, 166, 169, 182 Inflammation, 140, 158, 163, 172, 174, 178, 183, 186 Information Systems, 84, 163 Informed Consent, 8, 15, 163 Infuse, 163 Infusion, 78, 87, 163, 164, 185 Infusion Pumps, 87, 163 Ingestion, 159, 163, 164, 174 Inhalation, 23, 163, 174 Initiation, 70, 163 Initiator, 55, 163 Inlay, 163, 178 Inorganic, 23, 163 Insulin, 5, 6, 8, 10, 23, 27, 66, 113, 153, 159, 163, 164, 165, 185 Insulin Infusion Systems, 163, 164 Insulin-dependent diabetes mellitus, 23, 164 Intensive Care, 25, 62, 164 Interindividual, 37, 164 Interleukin-1, 21, 164 Interleukin-2, 164 Intestinal, 112, 159, 164 Intestine, 145, 164, 165 Intracellular, 14, 163, 164, 170, 175 Intraocular, 164, 185 Intraocular pressure, 164, 185 Intravascular, 160, 164 Intravenous, 55, 64, 163, 164 Intrinsic, 58, 65, 69, 107, 140, 164 Intubation, 147, 164 Invasive, 14, 24, 25, 26, 27, 60, 66, 70, 77, 84, 94, 162, 164, 166, 171 Involuntary, 4, 157, 164, 169, 173, 181 Ion Channels, 14, 164 Ionizing, 140, 156, 164 Ions, 69, 139, 144, 154, 155, 162, 165 Ischemia, 3, 19, 20, 49, 57, 58, 72, 89, 97, 98, 143, 165 Ischemic stroke, 55, 165 Isoelectric, 49, 88, 91, 165 Isoelectric Point, 91, 165 J Joint, 165, 183

K Kainic Acid, 11, 165 Kb, 122, 165 Ketone Bodies, 153, 165 Ketosis, 153, 165 Kidney Disease, 3, 8, 113, 122, 165 Kinetic, 164, 165 L Large Intestine, 153, 164, 165, 177, 180 Lethal, 61, 165 Leukemia, 36, 139, 165 Leukocytes, 145, 148, 152, 165, 168 Library Services, 134, 166 Licensed practical nurse, 15, 166 Life cycle, 145, 166 Ligaments, 151, 166 Linkage, 16, 166 Lipid, 8, 18, 117, 148, 164, 166 Liver, 139, 140, 142, 144, 149, 157, 158, 159, 161, 166, 186 Localized, 160, 163, 166, 173 Locomotor, 166, 179 Loop, 58, 164, 166 Lower Esophageal Sphincter, 159, 166 Lumen, 105, 146, 166 Lupus, 117, 166, 183 Lymph, 144, 149, 156, 166 Lymphatic, 156, 163, 166 Lymphocytes, 142, 162, 164, 165, 166 M Macrophage, 164, 166 Magnetic Resonance Imaging, 65, 166 Malaria, 36, 166, 167 Malaria, Falciparum, 166, 167 Malaria, Vivax, 166, 167 Malnutrition, 140, 143, 167 Mammary, 151, 167 Mammogram, 146, 167 Mediate, 71, 154, 167, 168 MEDLINE, 123, 167 Membrane, 22, 69, 147, 150, 153, 156, 164, 167, 168, 171, 173, 177, 178, 179, 181 Memory, 67, 73, 75, 153, 167 Meninges, 148, 152, 167, 182 Menopause, 17, 167, 175 Menstrual Cycle, 167, 175 Menstruation, 167 Mental, iv, 10, 122, 124, 153, 154, 157, 163, 167, 175, 176, 177, 186 Mental Disorders, 167, 175, 176 Mental Health, iv, 10, 122, 124, 167, 175, 177

Index 195

MI, 5, 14, 19, 55, 72, 80, 137, 167 Microbe, 167, 185 Microbiology, 143, 144, 167 Microcalcifications, 146, 167 Microorganism, 167, 187 Microspheres, 19, 168 Mobility, 19, 168 Modeling, 26, 168 Modification, 89, 141, 168, 177 Molecular, 13, 16, 22, 23, 123, 125, 144, 148, 150, 158, 160, 168, 174, 185 Molecular Chaperones, 22, 148, 160, 168 Molecule, 142, 144, 149, 154, 156, 157, 162, 168, 171, 177, 186 Monitor, 11, 24, 49, 53, 54, 62, 67, 68, 74, 79, 83, 87, 90, 94, 97, 99, 102, 152, 168, 170 Monocytes, 164, 165, 168 Morphology, 32, 86, 90, 92, 168 Motility, 5, 11, 112, 168, 179 Motion Sickness, 168, 169 Motor Activity, 11, 151, 168 Mucosa, 166, 168 Muscle Contraction, 63, 168 Muscle Fibers, 56, 81, 143, 168, 169, 180, 185 Myocardial infarction, 10, 14, 19, 27, 29, 33, 37, 55, 69, 72, 77, 80, 83, 89, 97, 152, 167, 168, 169 Myocardial Ischemia, 5, 49, 58, 88, 104, 141, 151, 168 Myocardium, 24, 56, 63, 70, 71, 72, 141, 167, 168, 169 Myosin, 168, 169, 185 Myotonic Dystrophy, 32, 169 N Naloxone, 169 Naltrexone, 12, 169 Narcotic, 169 Nausea, 9, 163, 165, 169, 172, 186 Need, 3, 15, 36, 54, 60, 62, 73, 80, 85, 90, 93, 112, 117, 130, 139, 169, 184 Neonatal, 13, 14, 51, 52, 128, 169 Nephrologist, 8, 169 Nephropathy, 3, 113, 165, 169 Nerve, 4, 11, 42, 113, 139, 141, 144, 157, 169, 178, 179, 182, 185 Nervous System, 11, 63, 107, 143, 148, 160, 169, 171, 179, 182, 183 Neural, 49, 169 Neurologic, 9, 65, 169 Neuromuscular, 32, 139, 157, 169, 186

Neuromuscular Junction, 139, 169 Neuropathy, 143, 169 Neurophysiology, 153, 169 Neurotoxicity, 165, 169 Neurotransmitter, 139, 141, 145, 154, 164, 169, 182 Neutrons, 140, 170, 177 Nitric Oxide, 37, 170 Nitrogen, 10, 140, 170 Nitroprusside, 37, 170 Normal Distribution, 83, 170 Normotensive, 31, 170 Nuclear, 8, 65, 140, 170 Nuclei, 140, 157, 166, 170, 176 Nucleic acid, 170, 175 Nucleus, 152, 166, 168, 170, 176, 181 O Obsessive-Compulsive Disorder, 158, 170 On-line, 17, 77, 137, 170 Oophorectomy, 170, 183 Opacity, 153, 170 Opiate, 12, 169, 170 Opium, 170 Orchiectomy, 171, 183 Organ Culture, 171, 184 Osmolality, 10, 171 Osmoles, 171 Osmotic, 140, 171 Outpatient, 9, 171 Ovaries, 170, 171, 180, 183 Ovum, 152, 166, 171, 175 Oxidation, 144, 153, 171 Oximetry, 87, 171 Oxygen Consumption, 157, 171, 178 Oxygenator, 146, 171 P Pacemaker, 13, 55, 59, 171 Palliative, 171, 184 Palsy, 140, 171 Pancreas, 139, 161, 163, 171, 172 Pancreatic, 159, 172 Pancreatic Juice, 159, 172 Pancreatitis, 10, 172 Panic, 158, 162, 172 Panic Disorder, 158, 162, 172 Papilla, 172 Papillary, 20, 172 Paroxysmal, 141, 160, 172 Patch, 13, 22, 51, 52, 74, 99, 151, 172 Pathologic, 98, 139, 144, 151, 172 Pathologies, 98, 172 Pathophysiology, 13, 172

196

Electrocardiogram

Patient Education, 113, 132, 134, 137, 172 Peptide, 15, 141, 172, 176 Percutaneous, 18, 70, 80, 172 Perennial, 162, 172 Perfusion, 6, 56, 63, 64, 72, 105, 172 Pericarditis, 28, 44, 172 Pericardium, 172, 183 Perioperative, 28, 172 Peripheral Vascular Disease, 113, 172 Perirhinal, 11, 173 Perspiration, 50, 173 PH, 64, 173 Pharmacokinetic, 173 Pharmacologic, 141, 173, 185 Pharynx, 159, 173 Phospholipids, 157, 173 Physical Examination, 8, 9, 12, 16, 66, 113, 148, 173 Physical Fitness, 173, 181 Physiologic, 21, 23, 49, 57, 75, 140, 157, 167, 173, 177, 183 Physiology, 11, 26, 36, 60, 146, 155, 169, 173, 186 Piloerection, 11, 173 Pilot study, 11, 173 Placenta, 173, 175 Plague, 80, 173 Plants, 140, 145, 146, 148, 159, 162, 168, 173, 185 Plaque, 141, 173 Plasma, 10, 22, 24, 140, 147, 158, 159, 161, 174 Plasma protein, 140, 174 Plasmin, 158, 174, 184, 186 Plasminogen, 24, 158, 174, 184, 186 Plasminogen Activator Inhibitor 1, 24, 174 Plasminogen Activators, 174 Platelet Aggregation, 170, 174 Platelets, 170, 174, 179, 184 Platinum, 166, 174 Plethysmography, 62, 174 Pneumonia, 151, 174 Poisoning, 148, 169, 174 Polydipsia, 10, 174 Polyphagia, 10, 174 Polyuria, 10, 174 Pons, 140, 157, 174 Port, 66, 174, 175 Port-a-cath, 174, 175 Posterior, 19, 102, 141, 142, 154, 171, 175 Postmenopausal, 18, 117, 175 Postoperative, 21, 175

Potassium, 14, 22, 39, 69, 175, 177 Potentiates, 164, 175 Power Sources, 96, 175 Practice Guidelines, 124, 128, 175 Precipitating Factors, 10, 160, 175 Precordial, 48, 78, 85, 103, 175 Preoperative, 21, 175 Prevalence, 3, 4, 5, 6, 14, 20, 23, 25, 94, 117, 175 Primary endpoint, 24, 175 Primary Prevention, 15, 23, 175 Prion, 68, 148, 175 Progesterone, 17, 37, 175, 182 Programmed Instruction, 111, 176 Progression, 23, 62, 113, 141, 176 Progressive, 26, 149, 153, 154, 156, 159, 169, 176 Projection, 49, 90, 176 Proliferative Retinopathy, 113, 176 Promyelocytic leukemia, 36, 176 Prone, 24, 51, 75, 176 Proportional, 171, 176 Protease, 176, 184 Protein C, 140, 144, 176, 185, 186 Protein S, 144, 176 Proteolytic, 149, 158, 174, 176, 184, 186 Protocol, 21, 176 Protons, 140, 162, 164, 176, 177 Protozoan, 148, 166, 176 Proximal, 70, 105, 154, 176, 179 Pruritus, 176, 179, 186 Psychiatric, 8, 9, 167, 176, 180 Psychiatry, 11, 37, 176, 187 Psychic, 167, 176, 179 Public Health, 15, 19, 22, 25, 75, 124, 176 Public Policy, 123, 177 Pulmonary, 23, 37, 44, 76, 98, 145, 151, 157, 160, 177, 187 Pulmonary Artery, 98, 145, 177, 187 Pulmonary Circulation, 76, 177 Pulmonary Valve, 160, 177 Pulsation, 105, 158, 177 Pulse, 15, 55, 56, 58, 59, 60, 61, 62, 63, 65, 69, 77, 79, 81, 100, 168, 171, 177 Q Quality of Life, 18, 80, 104, 177 Quinidine, 37, 177 Quinine, 177 R Radiation, 66, 141, 156, 158, 164, 177, 187 Radioactive, 23, 63, 64, 65, 162, 170, 177 Radiological, 172, 177

Index 197

Radiopharmaceutical, 159, 177 Randomized, 12, 155, 177 Receptor, 142, 154, 165, 177, 179 Rectum, 142, 145, 153, 158, 165, 177 Recurrence, 24, 31, 56, 177 Reentry, 70, 177 Refer, 1, 145, 149, 170, 178, 179, 185 Reflux, 7, 112, 159, 178 Refraction, 178, 181 Refractory, 13, 36, 178 Regimen, 62, 155, 178 Regression Analysis, 154, 178 Regurgitation, 20, 159, 160, 178 Reliability, 32, 71, 178 Remission, 177, 178 Research Design, 26, 178 Respiration, 77, 142, 146, 168, 178 Respirators, 87, 178 Restoration, 56, 72, 178 Resuscitation, 5, 19, 56, 80, 146, 178 Retina, 151, 176, 178, 179 Retinopathy, 4, 6, 178 Retrograde, 98, 178 Reversion, 147, 179 Risk factor, 4, 5, 6, 15, 25, 113, 117, 179 Rod, 149, 179 S Saphenous, 151, 179 Saphenous Vein, 151, 179 Scrapie, 68, 179 Screening, 5, 7, 12, 25, 31, 94, 95, 102, 113, 149, 179, 186 Secretion, 11, 27, 164, 173, 179 Sedative, 162, 179 Sediment, 179, 186 Segmental, 64, 179 Segmentation, 179 Seizures, 11, 156, 172, 179, 181 Sensor, 74, 81, 87, 96, 106, 164, 179 Septal, 179 Septum, 59, 143, 179 Septum Pellucidum, 179 Sequencing, 179, 183 Sequester, 148, 179 Serine, 179, 184 Serology, 113, 179 Serotonin, 158, 170, 179 Serum, 10, 20, 36, 140, 149, 179, 180 Sex Characteristics, 180, 183 Shock, 54, 56, 61, 80, 100, 147, 148, 155, 180, 185 Side effect, 139, 180, 185

Sinoatrial Node, 73, 180 Skeletal, 149, 177, 180, 181, 185 Skeleton, 94, 139, 165, 180 Skull, 145, 152, 180, 183 Sleep apnea, 15, 75, 180 Sleep Deprivation, 21, 180 Small intestine, 155, 161, 164, 180 Smoking Cessation, 145, 180 Social Environment, 177, 180 Social Work, 9, 180 Sodium, 14, 37, 69, 177, 180, 183 Soft tissue, 145, 180 Solitary Nucleus, 143, 181 Solvent, 171, 181 Soma, 181 Somatic, 4, 181 Sound wave, 104, 150, 181 Spasm, 151, 181 Specialist, 113, 129, 181 Species, 23, 166, 177, 181, 182, 185, 187 Specificity, 14, 20, 140, 181 Spectrum, 11, 16, 60, 94, 95, 181 Spike, 82, 181 Spinal cord, 148, 156, 160, 167, 169, 181, 182, 183 Sports Medicine, 82, 132, 181 Standard therapy, 71, 181 Status Epilepticus, 11, 181 Steel, 149, 181 Stenosis, 6, 32, 181, 182 Stent, 80, 181 Sterile, 67, 182 Steroid, 152, 160, 182 Stimulus, 18, 151, 154, 155, 156, 164, 182, 184 Stomach, 7, 139, 143, 153, 156, 158, 159, 161, 165, 166, 169, 173, 178, 180, 182 Stress, 6, 8, 17, 21, 30, 76, 104, 112, 117, 143, 148, 152, 155, 169, 182 Stricture, 181, 182 Stroke, 15, 44, 55, 56, 75, 122, 146, 147, 165, 182 Subacute, 163, 182 Subarachnoid, 25, 160, 182 Subclavian, 105, 144, 182 Subclavian Artery, 105, 182 Subclinical, 16, 163, 179, 182 Subcutaneous, 50, 72, 155, 182 Subspecies, 181, 182 Substance P, 179, 182 Substrate, 51, 182 Suction, 50, 182

198

Electrocardiogram

Sudden cardiac death, 32, 56, 59, 80, 90, 94, 182 Sudden death, 3, 11, 22, 24, 32, 80, 83, 94, 182 Superior vena cava, 180, 182 Supraventricular, 24, 71, 182 Surgical castration, 30, 183 Survival Rate, 4, 56, 71, 81, 183 Sweat, 173, 183 Sympathetic Nervous System, 143, 183 Symptomatic, 12, 172, 183 Synapse, 139, 169, 183, 185 Synchrony, 19, 183 Systemic, 18, 23, 76, 105, 117, 142, 145, 163, 183 Systemic lupus erythematosus, 117, 183 Systole, 33, 57, 59, 105, 160, 183 Systolic, 4, 8, 25, 26, 33, 64, 104, 162, 183 Systolic blood pressure, 8, 183 T Tachyarrhythmia, 71, 183 Tachycardia, 24, 26, 32, 34, 54, 71, 83, 100, 183 Telecommunications, 150, 183 Temporal, 20, 32, 37, 49, 60, 63, 160, 183 Testicles, 171, 183 Testosterone, 30, 183 Thalassemia, 13, 183 Therapeutics, 5, 42, 184 Thoracic, 57, 105, 153, 182, 184 Thorax, 48, 59, 175, 182, 184 Threshold, 18, 69, 71, 101, 156, 162, 184 Thrombin, 157, 158, 174, 176, 184 Thromboembolism, 163, 184 Thrombolytic, 14, 55, 72, 174, 184 Thrombolytic Therapy, 14, 184 Thrombosis, 176, 182, 184 Thrombus, 55, 72, 152, 163, 165, 168, 174, 184 Thyroid, 162, 184, 186 Thyroid Gland, 162, 184 Thyroxine, 140, 184 Tissue Culture, 22, 184 Tissue Plasminogen Activator, 55, 72, 184 Tolerance, 6, 8, 159, 160, 184 Tomography, 64, 90, 150, 184 Tone, 170, 184, 185 Tonic, 11, 185 Tonometry, 42, 185 Torsion, 163, 185 Toxic, iv, 9, 23, 156, 162, 169, 185 Toxicity, 23, 154, 185

Toxicokinetics, 185 Toxicology, 111, 124, 185 Toxin, 184, 185 Traction, 149, 185 Transcutaneous, 42, 79, 185 Transduction, 74, 160, 185 Transfection, 144, 185 Transfusion, 13, 185 Translocation, 23, 185 Transmitter, 17, 99, 139, 154, 164, 185 Transplantation, 105, 162, 185 Trauma, 10, 172, 185 Tricyclic, 162, 185 Tropomyosin, 185 Troponin, 20, 185 Type 2 diabetes, 3, 5, 10, 16, 113, 185 Tyrosine, 147, 154, 186 U Unconscious, 61, 141, 162, 186 Uraemia, 172, 186 Urea, 145, 183, 186 Urethra, 186 Urinalysis, 10, 113, 186 Urinary, 144, 174, 184, 186 Urinary Plasminogen Activator, 184, 186 Urine, 10, 12, 21, 144, 145, 152, 153, 165, 174, 186 Urokinase, 174, 186 Uterus, 152, 162, 167, 171, 175, 186 V Vaccine, 176, 186 Valves, 24, 59, 98, 178, 186 Vascular, 6, 9, 62, 65, 151, 156, 160, 163, 170, 173, 174, 184, 186 Vasculitis, 172, 186 Vasodilator, 145, 154, 170, 186 Vasomotor, 11, 186 Vector, 27, 111, 185, 186 Vein, 144, 164, 170, 179, 182, 186 Venous, 142, 144, 152, 176, 186 Ventilation, 146, 186 Ventricle, 57, 63, 70, 105, 142, 143, 162, 177, 180, 183, 187 Ventricular Dysfunction, 26, 187 Ventricular fibrillation, 4, 18, 19, 54, 56, 58, 71, 80, 92, 100, 187 Venules, 145, 187 Veterinary Medicine, 37, 103, 123, 187 Viral, 185, 187 Virulence, 185, 187 Virus, 144, 148, 173, 185, 187 Visceral, 5, 143, 187

Index 199

Visceral Afferents, 143, 187 Vitro, 17, 187 Vivo, 17, 187 Volition, 164, 187

X Xenograft, 141, 187 X-ray, 6, 8, 65, 90, 109, 141, 147, 150, 151, 158, 167, 170, 187

200

Electrocardiogram