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

HOT

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

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

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

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Hot Flashes: 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: 0-597-83710-4 1. Hot Flashes-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 hot flashes. 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 HOT FLASHES ........................................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Hot Flashes.................................................................................... 5 The National Library of Medicine: PubMed ................................................................................ 22 CHAPTER 2. NUTRITION AND HOT FLASHES.................................................................................. 39 Overview...................................................................................................................................... 39 Finding Nutrition Studies on Hot Flashes .................................................................................. 39 Federal Resources on Nutrition ................................................................................................... 42 Additional Web Resources ........................................................................................................... 42 CHAPTER 3. ALTERNATIVE MEDICINE AND HOT FLASHES ........................................................... 45 Overview...................................................................................................................................... 45 National Center for Complementary and Alternative Medicine.................................................. 45 Additional Web Resources ........................................................................................................... 52 General References ....................................................................................................................... 56 CHAPTER 4. DISSERTATIONS ON HOT FLASHES ............................................................................. 57 Overview...................................................................................................................................... 57 Dissertations on Hot Flashes ....................................................................................................... 57 Keeping Current .......................................................................................................................... 57 CHAPTER 5. CLINICAL TRIALS AND HOT FLASHES ........................................................................ 59 Overview...................................................................................................................................... 59 Recent Trials on Hot Flashes ....................................................................................................... 59 Keeping Current on Clinical Trials ............................................................................................. 65 CHAPTER 6. PATENTS ON HOT FLASHES ........................................................................................ 67 Overview...................................................................................................................................... 67 Patents on Hot Flashes................................................................................................................. 67 Patent Applications on Hot Flashes............................................................................................. 76 Keeping Current .......................................................................................................................... 81 CHAPTER 7. BOOKS ON HOT FLASHES ............................................................................................ 83 Overview...................................................................................................................................... 83 Book Summaries: Federal Agencies.............................................................................................. 83 Book Summaries: Online Booksellers........................................................................................... 84 The National Library of Medicine Book Index ............................................................................. 85 Chapters on Hot Flashes .............................................................................................................. 86 CHAPTER 8. MULTIMEDIA ON HOT FLASHES ................................................................................. 87 Overview...................................................................................................................................... 87 Bibliography: Multimedia on Hot Flashes ................................................................................... 87 CHAPTER 9. PERIODICALS AND NEWS ON HOT FLASHES .............................................................. 89 Overview...................................................................................................................................... 89 News Services and Press Releases................................................................................................ 89 Newsletter Articles ...................................................................................................................... 92 Academic Periodicals covering Hot Flashes................................................................................. 93 CHAPTER 10. RESEARCHING MEDICATIONS................................................................................... 95 Overview...................................................................................................................................... 95 U.S. Pharmacopeia....................................................................................................................... 95 Commercial Databases ................................................................................................................. 96 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 101 Overview.................................................................................................................................... 101 NIH Guidelines.......................................................................................................................... 101 NIH Databases........................................................................................................................... 103

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Other Commercial Databases..................................................................................................... 105 APPENDIX B. PATIENT RESOURCES ............................................................................................... 107 Overview.................................................................................................................................... 107 Patient Guideline Sources.......................................................................................................... 107 Finding Associations.................................................................................................................. 112 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 115 Overview.................................................................................................................................... 115 Preparation................................................................................................................................. 115 Finding a Local Medical Library................................................................................................ 115 Medical Libraries in the U.S. and Canada ................................................................................. 115 ONLINE GLOSSARIES................................................................................................................ 121 Online Dictionary Directories ................................................................................................... 121 HOT FLASHES DICTIONARY................................................................................................... 123 INDEX .............................................................................................................................................. 163

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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 hot flashes 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 hot flashes, 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 hot flashes, 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 hot flashes. 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 hot flashes, 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 hot flashes. 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 HOT FLASHES Overview In this chapter, we will show you how to locate peer-reviewed references and studies on hot flashes.

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

Physiology, Medical Management and Oral Implications of Menopause Source: JADA. Journal of the American Dental Association. 133(1): 73-81. January 2002. Contact: Available from American Dental Association. ADA Publishing Co, Inc., 211 East Chicago Avenue, Chicago, IL 60611. (312) 440-2867. Website: www.ada.org. Summary: Approximately 36 million women in the United States are in the postmenopausal phase of life. The physiological changes associated with spontaneous or surgical menopause (after surgical removal of both ovaries) cause some women to experience uncomfortable symptoms such as hot flashes, night sweats, and vaginal dryness. In addition, estrogen deprivation arising from menopause in association with age-related factors disproportionately increases the risk of developing cardiovascular disease, osteoporosis, Alzheimer disease, and oral disease. Hormone replacement

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therapy (HRT, featuring estrogen or estrogen and progestin) often is prescribed on a short term basis to alleviate the uncomfortable symptoms associated with estrogen deficiency and on a long term basis to prevent some of the chronic illnesses common to postmenopausal women. This article reviews the physiology, medical management, and oral implications of menopause. Dentists who treat women entering menopause need to consider the stressful phase of life their patients are experiencing. Clinical findings of postmenopausal problems on dental examination may include a lack of saliva, increased dental caries (cavities), dysesthesia (reduced or altered sense of feeling), taste alterations, atrophic gingivitis (inflammation of the gums), periodontitis, and osteoporotic jaws unsuitable for conventional prosthetic devices or dental implants. Panoramic dental radiographs may reveal calcified carotid artery atheromas. The author stresses that dentists have an opportunity to refer women who are not under the care of a gynecologist for an evaluation to determine the appropriateness of HRT for its systemic and oral health benefits. 1 figure. 111 references. •

Menopause: Transition with Balance Source: Diabetes Forecast. 54(3): 37-39. March 2001. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article discusses the challenges facing women who have diabetes during their transition to menopause. For most women, menopause occurs around the age of 51, and this natural transition is often accompanied by symptoms such as hot flashes, vaginal dryness, sleeplessness, and irritability. The years prior to menopause are referred to as the perimenopausal years. During this time, the menstrual cycle becomes more irregular and symptoms associated with menopause begin. For women who have diabetes, this is also the time when blood glucose levels fluctuate widely. Diabetes control may suffer because, as estrogen production decreases, the body may become more resistant to insulin. As the levels of estrogen and progesterone drop off permanently, the body once again becomes more sensitive to insulin. At this stage, hypoglycemia can occur more often. Menopause is also the time when a woman's risk for heart disease, osteoporosis, and other chronic health problems increases. Women who have diabetes already have an increased risk of heart disease and a slightly increased risk of osteoporosis. Symptoms associated with menopause, including hot flashes, moodiness, short term memory loss, sweating, and flushing, can be confused with the symptoms of both low and high blood glucose. Women who have diabetes need to check their blood glucose levels more often to determine whether they are experiencing a low or menopausal symptoms. Vaginal dryness and frequent vaginal and urinary tract infections can also occur during menopause. These problems can be made worse by persistent high blood glucose levels. Women can adjust their diabetes regimen to reduce the frequency of high and low blood glucose levels.

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Hormone Replacement: More Than Just Estrogen Source: Diabetes Self-Management. 15(2): 58, 60-62. March-April 1998. Contact: Available from R.A. Rapaport Publishing, Inc. 150 West 22nd Street, New York, NY 10011. (800) 234-0923. Summary: This article focuses on the use of hormone replacement therapy following menopause to reduce the risk of heart disease in women, particularly women with diabetes. It describes the normal body changes that occur during menopause. Early signs of menopause include irregular periods, hot flashes, and night sweats.

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Menopause can also weaken the muscles and tissues of the vagina and the base of the bladder. The article identifies the potential benefits of hormone replacement therapy, including reducing the risk of heart disease and preventing osteoporosis. It highlights potential concerns about hormone replacement therapy, including impairing blood glucose control, affecting blood pressure, and increasing the risk of developing blood clots and breast and endometrial cancer. The article discusses the available choices for hormone replacement and stresses the need for women with diabetes to talk with a doctor about hormone replacement therapy. It also includes a list of organizations and books that provide information about menopause and the pros and cons of hormone replacement therapy. •

Managing Menopause Without Estrogen Source: Diabetes Self-Management. 11(1): 38-42. January-February 1994. Contact: Available from R.A. Rapaport Publishing, Inc. 150 West 22nd Street, New York, NY 10011. (800) 234-0923. Summary: This article provides readers with an overview of hormone replacement therapy and a guide to nonhormonal therapy for managing menopause and preventing postmenopausal cardiovascular disease. The authors review the patients for whom nonhormonal therapy might be appropriate, cautioning that most of the nonhormonal treatment options have not yet been subjected to controlled scientific evaluations. The authors discuss symptoms and the recommended treatment options for each. Topics include hot flashes; sexual problems; urinary tract problems; and other menopausal symptoms, including irritability, mood swings, sleep disorders, and fluid retention. The article concludes with a discussion of cardiovascular disease and ways to minimize the potential for heart problems.

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

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

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Project Title: ACUPUNCTURE FOR HOT FLASHES IN CANCER PTS: PILOT FOR RCT Principal Investigator & Institution: Cassileth, Barrie R.; Chief; Sloan-Kettering Institute for Cancer Res New York, Ny 10021 Timing: Fiscal Year 2003; Project Start 06-AUG-2003; Project End 31-JUL-2005 Summary: (provided by applicant): BACKGROUND: Hot flashes are a common sideeffect of treatment for breast and prostate cancer. Between one-half and two-thirds of breast and prostate cancer patients report hot flashes, and many of these rate their problem as moderately or extremely severe. Several drugs are available, but clinically relevant adverse effects are common and response rates are moderate. Endogenous opioids have been implicated in hot flashes. It is known that acupuncture leads to endorphin release and there is also preliminary evidence that acupuncture may lead to changes in the genetic expression of endogenous opioids. Several single-arm studies have shown large and persistent decreases in hot flashes following acupuncture treatment. A randomized trial in menopausal hot flashes also had encouraging results. These considerations warrant further research on acupuncture for hot flashes associated with cancer treatment. OBJECTIVES: 1. To determine whether a Phase III trial of acupuncture for hot flashes in breast and/or prostate cancer is warranted: 2. To determine whether a Phase III trial is feasible; 3. To determine whether breast and prostate cancer patients should be combined in a single Phase III trial; 4. To determine whether severity of hot flashes need be assessed; 5. To provide data necessary for sample size calculation METHODS: Cancer patients with treatment related hot flashes will complete a diary of hot flashes for one week. They will then be randomized to eight sessions of true or placebo acupuncture over four weeks. Placebo acupuncture consists of a needle that retracts inside its handle, a method that has been shown to be credible to patients. Hot flash diaries will be completed at six, 13 and 26 weeks following randomization. Change in hot flash frequency and hot flash score (frequency multiplied by severity) will be compared by analysis of co-variance. Breast and prostate patients will be accrued and analyzed separately. Data will be combined for exploratory analyses: a test for interaction will be made to determine whether acupuncture has differential effects on hot flashes by type of cancer. At the end of the trial we will have data to address each of our objectives as follows: Objective 1: Confidence interval for the difference between group means; Objective 2: Accrual rate, drop-out rate, compliance with treatment, use of off-study treatments; Objective 3: Interaction between diagnosis and treatment effect, relative accrual and drop-out rate, relative compliance; Objective 4: Correlation between hot flash score and hot flash frequency; Objective 5: Standard deviations, mean of control group, correlation between and within baseline and followup measures. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ACUPUNCTURE FOR HOT FLASHES IN PROSTATE CANCER PATIENTS Principal Investigator & Institution: Beer, Tomasz M.; Associate Professor; Medicine; Oregon Health & Science University Portland, or 972393098 Timing: Fiscal Year 2003; Project Start 14-JUL-2003; Project End 30-JUN-2005 Summary: (provided by applicant): Up to 80% of men treated with androgen deprivation for prostate cancer suffer from hot flashes. Insomnia, fatigue, and irritability are often associated with hot flashes and adversely affect the quality of life for these patients. Several pharmacologic interventions can reduce hot flash frequency

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and intensity but have the potential for adverse effects. Acupuncture, a 23 centuries-old treatment modality, has been reported to substantially reduce hot flash frequency in 7 men treated with androgen deprivation for prostate cancer in Sweden. The study proposed here will apply validated methodology to assess the impact of acupuncture on hot flash frequency and intensity as well as hot flash related quality of life in an adequately powered phase Ii study. To extend current understanding of the physiologic changes associated with hot flashes and with acupuncture, the impact of acupuncture on serotonin and its metabolites, metabolites of brain norepinephrine, and circulating calcitonin gene-related peptide (CGRP) will be evaluated. All three of these systems have been implicated in the pathophysiology of thermoregulatory instability associated with hot flashes. Serotonin and norepinephrine are amongst the targets of western pharmacologic treatment for hot flashes. Preliminary data suggest that acupuncture may mediate changes in circulating serotonin and CGRP. Promising results in this pilot trial will lead to randomized studies of acupuncture compared to pharmacologic therapy and pilot studies of acupuncture combined with western treatment. The overall goal is to provide prostate cancer patients an effective, low toxicity, non-pharmacologic treatment modality for hot flashes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ALTERNATIVE THERAPIES FOR MENOPAUSE: A RANDOMIZED TRIAL Principal Investigator & Institution: Newton, Katherine M.; Associate Investigator; Center for Health Studies Seattle, Wa 98101 Timing: Fiscal Year 2002; Project Start 01-JUL-2000; Project End 30-NOV-2004 Summary: (Adapted from Investigator's Abstract) Hormone replacement therapy (HRT: estrogen and progestin) remains the treatment of choice for women with vasomotor symptoms, and long-term HRT has been recommended for prevention purposes. The demand for alternatives to HRT, and the availability and use of over-the-counter products including dietary phytoestrogen supplements and naturopathic medicines, has grown dramatically. Few of these products have faced the rigors of randomized trials and none have been tested to evaluate their effects on long-term outcomes. The purpose of this four-year randomized controlled trial is to evaluate the efficacy and safety of three alternative approaches utilizing phytoestrogens to treat vasomotor symptoms in peri- and postmenopausal women. The treatments were chosen because of the scientific evidence supporting a possible benefit, the availability of products with adequate quality control their frequency of use in naturopathic medicine, and our ability to blind participants to the intervention. The five proposed treatment arms are as follow: 1) esterified estrogen and micronized progesterone: 9) a single herbal product, black cohosh; 3) a multibotanical preparation; 4) a combination regimen that includes the same multibotanical preparation plus soy diet counseling; and 5) placebo. The primary aim is to compare the effects of three alternative treatments, HRT, and placebo on the frequency and intensity of vasomotor symptoms measured by The Wiklund Menopause Symptom Checklist and a daily Vasomotor Symptom Diary. The secondary aims are to compare the effects of three alternative treatments, HRT, and placebo on the following: 1) vaginal cytology (vaginal maturation index); 2) serum lipids (total cholesterol, HDL and LDL cholesterol, triglycerides); 3) bone mineral density (hip and spine dual energy x-ray absorptiometry scan); 4) glucose metabolism (insulin, fasting blood glucose); and 5) coagulation factors (fibrinogen, PAI-1). The hypotheses are that compared to placebo the three alternative treatments tested in this study will have the following effects: reduce frequency of hot flashes and night sweats, improve vaginal maturation and

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decrease vagina atrophy as measured by maturation index, lower total cholesterol and LDL with no effect on HDL, reduce the rate of decline in bone mineral density (BMD), and have no effect on glucose metabolism or clotting factors. To accomplish the specific aims the investigators propose to do the following: 1) recruit and randomize 400 periand post-menopausal women to one of five treatment arms for one year; 2) collect measurements of primary and secondary outcomes at baseline, three, six, and 12 months; and 3) compare changes in outcomes in the groups taking alternative treatments to those in the HRT and placebo groups. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: AMINO ACID THERAPY FOR HOT FLASHES/POSTMENOPAUSAL WOMEN Principal Investigator & Institution: Guttuso, Thomas J.; Neurology; State University of New York at Buffalo 402 Crofts Hall Buffalo, Ny 14260 Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 31-AUG-2008 Summary: (provided by applicant): Hot flashes affect approximately 75% of postmenopausal women. Although hormone replacement therapy (HRT) is highly effective in reducing hot flashes, long-term HRT is associated with increased rates of breast cancer and heart disease. Safe, effective, and well-tolerated hot flash alternative therapies are needed. We have shown the anticonvulsant gabapentin to be effective in the treatment of hot flashes in postmenopausal women; however, 50% of patients receiving gabapentin reported side effects of sleepiness or dizziness. Gabapentin is known to bind to the alpha2delta subunit of voltage-gated calcium channels (VGCCs) in the central nervous system (CNS). The amino acids L-methionine and L-norleucine also bind to the alpha2delta subunit with high affinity. Recently, we have noted a 75-100% reduction in hot flash frequency among 5 women after initiating either open-label oral L-methionine or L-norleucine therapy. Long-term L-methionine therapy may carry increased cardiovascular risks by increasing serum homocysteine levels while Lnorleucine therapy will not increase homocysteine levels. Over the 5-year career development award, the applicant will principally pursue clinical research examining the safety, tolerability, and efficacy of L-norleucine therapy in hot flash treatment. The clinical research will be performed in the University's General Clinical Research Center under the mentorship of Drs. Kieburtz and Guzick. In addition to this clinical work, the applicant will concurrently pursue basic science training in the laboratory of co mentor Dr. Richfield on better elucidating the mechanism of action of L-norleucine therapy in the treatment of hot flashes and on optimizing future hot flash therapies. Direct mentored training will occur throughout the 5-year award. The applicant will participate in one clinical research meeting and one basic science journal club meeting every week. In addition, formal didactic training in epidemiology and neuroscience will occur at the University. The applicant will also attend two didactic training seminars in complementary & alternative medicine at The Osher Institute at Harvard Medical School and at the Duke Center for Integrative Medicine. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CCCWFU RESEARCH BASE GRANT Principal Investigator & Institution: Shaw, Edward G.; Professor and Chairman, Radiation Oncolo; Radiation Oncology; Wake Forest University Health Sciences Winston-Salem, Nc 27157 Timing: Fiscal Year 2002; Project Start 07-SEP-1999; Project End 31-MAY-2005

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Summary: (provided by applicant): The Comprehensive Cancer Center of Wake Forest University (CCCWFU) Community Clinical Oncology Program (CCOP) Research Base was funded in 9/99 (retroactive to 6/99) for three years. This application describes the administrative structure, including safety and monitoring procedures and clinical research activities of the Research Base for its five-year competitive renewal as a control/treatment CCOP Research Base. Participants in the Research Base include three CCOPs (Southeast Cancer Control Consortium, Winston-Salem, NC; Upstate Carolina CCOP, Spartanburg, SC; Greenville CCOP, Greenville SC) and four non-CCOP Prevention Members (East Carolina University, Greenville, NC; High Point Regional Health System, High Point, NC; InterCommunity Cancer Center, Rome, GA; WakeMed System, Cary, NC. The geographic region covered by these three CCOPs and four Prevention Members includes seven states (NC, SC, VA, WV, KY, TN, GA) with a population of approximately 12 million people, one-quarter of whom are minorities (60% minorities in coastal NC communities), served by 28 cancer centers. It is anticipated that an additional 3-6 CCOPs and Minority-Based CCOPs will join the CCCWFU CCOP Research Base by 12/01. Active and developing clinical trials of the Research Base are described in the application. In cancer control, there are 4 active and 13 developing studies, focusing on the following areas: complimentary and alternative medicine, symptom management, and quality of life, particularly in the setting of cancer related fatigue, anorexia/weight loss, depression, hot flashes, cognition and chemoprevention. In cancer treatment, there are 6 active and 7 developing studies, focusing on complementary, alternative, and conventional therapies primarily in lung, pancreas, and brain cancer. The spectrum of clinical research studies offered by the CCCWFU CCOP Research Base is complementary to, rather than competitive with, the cancer control/treatment protocols offered by the Cooperative Group Research Bases. Under the direction of Principal Investigator Edward G. Shaw, M.D., the Clinical Research Management administrative structure of the CCCWFU, and key leadership from the CCCWFU, CCOPs, and Prevention Members, the CCCWFU CCOP Research Base is fulfilling its primary goal of providing state-of-the-art intervention oriented clinical research studies in cancer prevention/control to CCOPs and patients (including minorities) in the Southeast United States. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CIMICIFUGA RACEMOSA AS A SEROTONIN MODULATOR Principal Investigator & Institution: Burdette, Joanna E.; Pharmacognosy; University of Illinois at Chicago 1737 West Polk Street Chicago, Il 60612 Timing: Fiscal Year 2001; Project Start 20-JUL-2001 Summary: (Provided by applicant): Despite the known correlation between estrogens and carcinogenesis, estrogen replacement therapy remains the number one treatment for menopausal symptoms. Cimicifuga racemosa is a rhizome that has been proven effective in reducing hot flashes in several clinical trials. The exact mechanism of action of the herb remains unknown. Studies may reveal that the plant works by modulating serotonin levels and thereby reduces hot flashes. If the plant ameliorates hot flashes without increasing estradiol levels, the botanical will provide a safe and effective solution for women with a history of breast cancer. The focus of this proposal is to train the applicant how to research botanicals by investigating the mechanism of Cimicifuga racemosa. The specific aims are (I.) to identify the active componant(s) of the plant using competitive serotonin receptor binding assays. (II.) Cellular in vitro studies will be conducted to determine the herbs agonistic or antagonistic properties, to establish and quantify serotonin subtype binding specificity, to characterize up- or down-regulation

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of receptor, and to monitor the serotonin dependent excretion of gonadotropic releasing hormones. (III.) Finally, an ovariectomized rat model will be used to evaluate the serotonergic effects of extracts and compounds in vivo. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CLINICAL EVALUATION OF BOTANICAL DIETARY SUPPLEMENT Principal Investigator & Institution: Derman, Richard J.; University of Illinois at Chicago 1737 West Polk Street Chicago, Il 60612 Timing: Fiscal Year 2002; Project Start 01-AUG-2002; Project End 31-JUL-2003 Summary: The overall objectives of this project are to conduct Phase I and II clinical trials of black cohosh (Cimicifuga racemosa) and red clover (Trifolium pratense), to be used for women's health problems-for menopausal hot flashes (primarily) and other somatic symptoms. Observational and epidemiological studies demonstrated that black cohosh is effective for menopausal women, and safe (at least in short-term). Phase I: The aims of this study is to determine safe doses (acute toxicity) of extracts of both botanicals, to be used in the subsequent Phase II clinical trial. Three doses will be tested over a one-week period in an attempt to determine symptoms of acute toxicity. There will be 5 subjects for each of 3 dosages (1X, 2X, 3X) of the 2 botanicals. (N=30) The goal is a sample size large enough to estimate unknown parameters Also studied will be pharmacokinetics (hourly bloods) absorption, distribution, metabolism, elimination, and pharmacological mode of action and side effects in healthy menopausal women. Phase II: This is a one year, randomized, controlled, double-blind efficacy study, the primary aim of which is to evaluate the efficacy of black cohosh and red clover, over a "safe dose range," for menopausal hot flashes. Additional goals are to assess these botanicals for other menopausal symptoms such as insomnia, joint pain, vaginal dryness, and dyspareunia (using Kupperman Index, bleeding scales and index of sexual function). They will also assess longer-term risks and safety issues and to determine changes in biomarkers (such as bone turnover and lipids) associated with use of these botanicals. Most previous studies of black cohosh lasted at most 6 months. Longer-term (1-year) safety data will be evaluated. In particular, incidence of endometrial hyperplasia, breakthrough bleeding, and other side effects will be determined. Subjects (n=112) will be randomized into one of 4 treatment groups (28/gr): placebo, Prempro 0.625/2.5, black cohosh and red clover. Also they will take blood samples to measure DNA oxidation products for measurements of DNA strand breaks using the comet assay to determine if DNA in peripheral blood leukocytes is being protected from damage through the antioxidant properties of the 'active' compounds or whether DNA damage is being produced (indicator of toxicity). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: EFFECT OF HORMONE THERAPY AND RALOXIFENE ON SERUM LIPIDS Principal Investigator & Institution: Roddy, Shirley J.; Learning Resource Center; University of Nebraska Medical Center Omaha, Ne 681987835 Timing: Fiscal Year 2001; Project Start 29-MAR-2001 Summary: This is a prospective, randomized, double-blinded clinical trial designed to compare the short-term effect of Raloxifene or Hormone Replacement Therapy (HRT) on serum lipids and lipoproteins of dyslipidemic postmenopausal women over time. Subjects will be randomized to receive either raloxifene 60 mg/d or conjugated equine estrogen 0.625 mg plus consecutive medroxyprogesterone acetate 2.5 mg/day (HRT).

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Serum lipoprotein(a), low-density lipoproteins, high-density lipoproteins, total cholesterol and triglycerides will be obtained at baseline, 3 months, and 6 months. The beneficial short-term effects of HRT on lipids and lipoproteins of dyslipidemic women has been established via clinical trials; however, the potential adverse effects of breast and endometrial cancer, hot flashes, and vaginal bleeding have been reported. Raloxifene is a selective estrogen receptor modulator that has estrogen-agonist effect on bone and estrogen antagonist effects on breast and uterus. Short term trials have demonstrated raloxifene reduces LDL and Lp(a) in healthy postmenopausal women with normal lipid panels. This study will add to the scientific body of evidence regarding raloxifene as a potential primary prevention alternative for dyslipidemic postmenopausal women. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EPIDEMIOLOGIC STUDY OF THE LATE REPRODUCTIVE YEARS Principal Investigator & Institution: Freeman, Ellen W.; Research Professor; Obstetrics and Gynecology; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104 Timing: Fiscal Year 2001; Project Start 10-FEB-1996; Project End 31-JAN-2006 Summary: (Adapted from the Investigator's Abstract) This is a prospective study of ovarian aging in African American and Caucasian women in their late reproductive years, commencing at ages 35-47 and continuing to ages 45-52. The specific aims are to 1) compare hormone dynamics (FSFL estradiol, DHEAS) and the follicular product inhibin between African American and Caucasian women; 2) evaluate menopauserelated symptoms over the study period and compare their severity and changes between African American and Caucasian women; and correlate physical and psychological factors (body mass, hot flashes, depression, steep disturbance and others) with hormone levels, fluctuations and rates of change and compare the associations between the two racial groups. The study is conducted with a randomly-identified population-based sample of approximately 400 women. The second phase of the study has four annual follow-up periods, each with two assessments at 1-month intervals, for a total of eight visits to collect blood samples for hormone assays and questionnaire data. More than 8O percent of U.S. women experience physical or psychological symptoms in the transition to menopause with varying degrees of severity and disruption of normal functioning. Whether these symptoms commonly attributed to the menopause are associated with the hormonal changes of the waning reproductive years is not well understood. Symptoms that diminish quality of life are a significant problem for women who experience them, their relationships and their productivity. Poor understanding of the symptoms and their associations with biological and environmental factors is a problem for health care when distressed women seek medical relief. This study provides the first information on racial differences in the associations between symptoms and the changing hormonal milieu compared between African American and Caucasian women. The investigators state that the findings will also inform clinicians addressing fertility problems of women in the late reproductive years and will increase understanding of the role of reproductive aging in the increased morbidity and mortality of postmenopausal women. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: OUTCOMES

ESTROGEN,

METABOLISM,

MENOPAUSE,

AND

HEALTH

Principal Investigator & Institution: Sowers, Maryfran R.; Professor; Epidemiology; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2003; Project Start 15-FEB-2003; Project End 31-JAN-2007 Summary: (provided by applicant): Emerging information suggests that differential expression in estrogen metabolism generates differences in health outcomes. Observations from ethnic groups, particularly comparisons of Asians and Caucasians, have precipitated both interest and controversy about differences in estrogen metabolism and health status. The goal of this application is to assess the contribution of estrogen metabolites and xenoestrogens as well as their potential signaling pathways to selected subsequent human health measures in women transitioning the menopause. We will 1) examine whether smoking and diet influence estrogen metabolism; 2) assay for both estrogens and phenolic products that contribute to the total ligand load and determine if estrogen effects on measures of health status (absolute level at follow-up or change from baseline) are misattributed because of failure to account for estrogen mimics; 3) examine the interaction between the arylhydrocarbon receptor (ArH) and ER receptors to ascertain if this interaction modifies the association of estrogens to subsequent measures of health status (absolute level at follow-up or change from baseline); and 4) use follicular and luteal phase samples, collected longitudinally across the menopausal transition, to ascertain if the relative hormone differences in the menstrual cycle segments over time are related to health outcomes. The measures of health status to be evaluated include vasomotor symptoms (hot flashes), age at menopause, measures of lipids and thrombosis and bone mineral density. This application will use Repository serum and urine samples from an existing large study of African-American, Caucasian, Chinese, Hispanic and Japanese women at the midlife [Study of Women's Health Across the Nation (SWAN)]. Additionally, SWAN can provide the longitudinal data about both smoking and diet exposures and health outcomes measures without additional data collection. This is a unique opportunity to prospectively integrate lifestyle elements with measures of hormone metabolism pathways into a comprehensive examination of multiple human health effects. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GABAPENTIN VS ESTROGEN FOR THE TREATMENT OF HOT FLUSHES Principal Investigator & Institution: Reddy, Sireesha; Obstetrics and Gynecology; University of Rochester Orpa - Rc Box 270140 Rochester, Ny 14627 Timing: Fiscal Year 2003; Project Start 01-MAY-2003; Project End 30-APR-2005 Summary: (provided by applicant): Hot flashes and other climacteric symptoms affect 75% of postmenopausal women in the US and are associated with higher rates of depression and sleep disturbance. Although hormone replacement therapy (HRT) is highly effective in reducing hot flashes, there is concern that HRT is associated with an increased risk of thrombo-embolic events, breast cancer and ovarian cancer. In addition, it is poorly tolerated in clinical practice, with about 30% of women discontinuing therapy after a mean of 4.5 months. Many other women have a contraindication to HRT, such as a history of an estrogen-sensitive tumor, liver dysfunction, or a hypercoagulable state. Safe, effective, and well-tolerated alternative therapies for hot flashes are needed. Gabapentin is a gamma-aminobutyric acid (GABA)-analog approved in 1994 for the

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treatment of seizures. Since then, it has been shown that gabapentin is efficacious for numerous off-label indications such as neuropathic pain, anxiety, bipolar disorder, and migraine headaches. The investigators have reported that gabapentin is associated with a reduction in the frequency of hot flashes in an uncontrolled series of postmenopausal women who were taking gabapentin for other indications. The investigators also report here preliminary data from a randomized, placebo-controlled trial showing that lowdose gabapentin was associated with a greater reduction in hot flash frequency than placebo after 12 weeks of treatment. However, it is not known whether the efficacy of gabapentin in the treatment of hot flashes and other menopausal symptoms is comparable to that of estrogen, the gold standard. A randomized trial of gabapentin, estrogen and placebo is needed to inform clinicians as to whether gabapentin is an effective alternative to estrogen. The first major aim of this proposal is to assess the screening and recruitment of menopausal women into a randomized trial of gabapentin, estrogen and placebo in the treatment of climacteric symptoms. The second major aim is to obtain preliminary estimates of the frequency and severity of climacteric symptoms among women receiving gabapentin, estrogen and placebo. Pilot data from these two aims will permit estimates of sample-size requirements for a full-scale randomized trial, and of the overall feasibility and cost of such a trial. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: INFLUENCE OF SOY CONSUMPTION ON MENOPAUSE IN JAPAN Principal Investigator & Institution: Melby, Melissa K.; Anthropology; Emory University 1784 North Decatur Road Atlanta, Ga 30322 Timing: Fiscal Year 2002; Project Start 01-AUG-2002 Summary: (provided by applicant): For two decades, anthropologists have been aware that the experience and symptoms of menopause (i.e., hot flashes, night sweats) may not be universal. Several researchers have hypothesized that dietary factors such as phytoestrogens (plant estrogenic chemicals) in soy, which is consumed in great quantities by the Japanese, may play a role in their lower rate of menopausal symptoms. This dissertation project will test a biocultural, reproductive ecology model of whether and how soy consumption affects the menopausal transition (konenki) in Japan. Specifically, we hypothesize that: (1) Women with higher phytoestrogen exposure/intake will have less frequent or severe midlife symptoms; and (2) Variance in gonadotropins (FSH and LH) will be negatively correlated with phytoestrogen exposure. Two populations of Japanese women, aged 45-55, from the Tohoku and Kinki regions of Japan (which have the highest and lowest soy consumption respectively, providing a natural experiment in phytoestrogen exposure) will be sampled longitudinally for levels of E2, FSH, LH, SHBG, and the phoytoestrogens genistein and diadzein. This study will characterize the menopausal transition in Japan from multiple perspectives: (1) endocrinological/physiological; (2) ecological (diet), and (3) experimental. By combining new assays for measurement of phytoestrogens with our well-validated finger prick blood spot methods, this project will provide a biocultural characterization of menopause in Japan. These data are sorely needed to model crosscultural variation at the end of the reproductive lifespan, and the influence of the environment on endocrinology and experience over the menopausal transition. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MELATONIN FOR SLEEP DISTURBANCES DURING MENOPAUSE Principal Investigator & Institution: Suhner, Andrea G.; Scripps Research Institute 10550 N Torrey Pines Rd La Jolla, Ca 920371000

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Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 16-MAR-2003 Summary: Up to half of all women going through menopause report significant sleep disturbance. A number of factors contribute to these sleep problems, with hormonal imbalance and hot flashes being the most important. Estrogen replacement therapy can alleviate these symptoms, yet side effects and contraindications make the use of this hormone replacement therapy (HRT) problematic in many women. As such, alternatives to traditional HRT are needed. Previous work in our lab has indicated that not only low levels of sex steroids but also the marked increase of gonadotropins observed during the menopause transition may play an important role in disturbed sleep experienced by peri- and postmenopausal women. In particular, our studies have shown that elevated levels of luteinizing hormone (LH) or a high ratio of LH-to-estradiol were associated with low sleep- efficiency in postmenopausal women. Hormonal imbalance also induces changes in the thermoregulatory system. The result is hot flashes and sweats, which can adversely affect night-time sleep quality The proposed study will test the hypothesis that exogenous melatonin decreases LH levels and in so doing, increases sleep quality. Furthermore, we hypothesize that melatonin will reduce severity and number of hot flashes by virtue of its temperature-lowering effect. As a consequence, the number of awakenings due to nocturnal hot flashes and night sweats will be reduced, leading to improved sleep quality. To test these hypotheses, twelve symptomatic peri- or postmenopausal women between the ages of 45-55 will ingest a daily dose of 3 mg melatonin or placebo every evening at bedtime over a period of 14 days. Each subject will undergo both conditions. At the end of each treatment session, subjects will spend two consecutive nights in the sleep laboratory. Polysomnographic sleep variables and core body temperature will be recorded continuously on both nights. Hot flashes will be objectively identified by measuring distal skin temperature and proximal skin resistance. Over-night urine samples will be collected to assess LH levels. Sleep parameters, temperature data, number of hot flashes and LH levels will be compared across active and control condition. The current project is an important first step to identify and assess a promising alternative for sleep disturbances in menopause. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MENOPAUSAL HOT FLASHES--EFFECT OF CHINESE HERBAL PREPARATION Principal Investigator & Institution: Kronenberg, Fredi; Columbia University Health Sciences New York, Ny 10032 Timing: Fiscal Year 2001 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PERIMENOPAUSAL ACUPUNCTURE

SYMPTOMS

MANAGEMENT

WITH

Principal Investigator & Institution: Cohen, Susan M.; Yale University 47 College Street, Suite 203 New Haven, Ct 065208047 Timing: Fiscal Year 2001 Summary: We propose to test the use of acupuncture for menopausal symptom relief for women who experience menopause following treatment for breast cancer. The study is designed to test the effect of acupuncture on the menopausal symptom of hot flashes, explore the anticipated treatment benefit of acupuncture on menopausal symptoms of mood changes, sleep disturbances, loss of concentration, joint pain, headache and

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nervousness as well as changes in ovarian hormones and quality of life, and increase the knowledge base concerning the effectiveness of alternative/complementary health practices. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PRIMATE MODEL OF MENOPAUSAL HOT FLASHES Principal Investigator & Institution: Freedman, Robert; University of Wisconsin Madison 750 University Ave Madison, Wi 53706 Timing: Fiscal Year 2001 Summary: OBJECTIVE To determine whether skin temperature and conductance (an electrical measure of sweating) could be measured in rhesus macaques for development of this animal model in the study of the etiology of hot flashes. RESULTS The animal was not anesthetized. Electrodes and thermisters, for measuring skin conductance and temperature, respectively, were applied to the ear pinna, forehead, calf and chest of a female rhesus macaque positioned in a restraining chair to which the animal had been previously accustomed for prolonged periods. The animal was allowed ad libitum access to food and water, and was watched continuously during data recording which took place in a room under precise temperature and humidity control. Data were recorded on two days for three to five hours each day. On the first day, baseline measurements were obtained for 90 minutes after which the room temperature raised and lowered a few degrees for 30 minutes then held at 35{C for approximately 30 minutes. Skin temperatures were stable during the baseline period and then showed the expected physiological responses to the ambient temperature changes. During the 30 minute heating period, fluctuations in skin conductance level sugges tive of sweating were seen in the calf. On the second day of data recording, the same animal was used. Baseline measurements were obtained for 125 minutes after which the ambient temperature was slowly raised to 40{C. Skin temperatures were stable during baseline, after which they increased with ambient temperature. Skin conductance level suggestive of sweating was seen in the sternum and calf during the heating period. The data demonstrate the feasibility of the proposed recording procedures. FUTURE DIRECTIONS We plan to conduct three short pilot studies in ovariectomized female macaques in the coming year to identify and validate one or more objective physiological markers that would indicate the occurance of a hot flash. KEY WORDS menopause, hot flashes, skin temperature; skin conductance; animal model development. FUNDING NIH PO1 AG11915, R37 AG05233, R21 application pending. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: RISK FACTORS FOR HOT FLASHES IN MID-LIFE Principal Investigator & Institution: Flaws, Jodi A.; Associate Professor; Epidemiology and Prev Medicine; University of Maryland Balt Prof School Baltimore, Md 21201 Timing: Fiscal Year 2001; Project Start 01-AUG-2001; Project End 31-JUL-2005 Summary: Many perimenopausal women experience hot flashes during mid-life. Hot flashes often have serious consequences, including fatigue, irritability, and acute physical discomfort that affects work and quality of life. Despite the high prevalence and importance of hot flashes, little is known about their risk factors. The proposed project will test the hypotheses that smoking, genetic polymorphisms in cytochrome P450 (CYP450) enzymes, and low serum estrogen levels are associated with an increased risk of hot flashes. It also will assess the hypothesis that smoking and CYP45O polymorphisms are associated with hot flashes via mechanisms that lower estrogen

16 Hot Flashes

levels. The specific aims are to: 1) determine whether cigarette smoking is associated with risk of hot flashes, 2) evaluate whether CYP45O polymorphisms are associated with risk of hot flashes, 3) assess whether low levels of serum estrogens are associated with risk of hot flashes, and 4) determine whether women exposed to both smoking and genetic polymorphisms have a different risk of hot flashes than women exposed to one or none of these risk factors. To complete the study, 400 perimenopausal women (45-54 years) with hot flashes (200 cases) or without hot flashes (200+ controls) will be recruited from Baltimore and the surrounding areas. Each participant will complete a questionnaire that assesses hot flash and smoking history, other potential risk factors, and potential confounders. Participants also will provide blood samples for analysis of estrogen levels and CYP450 genetic polymorphisms. Associations between hot flashes, smoking, estrogen levels, and CYP450 polymorphisms then will be assessed using appropriate statistical and analytic methods. The results of this study will provide information about risk factors for perimenopausal hot flashes, particularly the influence of smoking, CYP450 polymorphisms, and serum estrogen levels. These results ultimately may be useful for future studies on the prevention and/or treatment of hot flashes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SLEEP IN OLDER WOMEN--EFFECTS OF ESTROGEN Principal Investigator & Institution: Moe, Karen E.; Psychiatry and Behavioral Scis; University of Washington Seattle, Wa 98195 Timing: Fiscal Year 2001; Project Start 01-MAY-1998; Project End 31-OCT-2003 Summary: (adapted from investigator's abstract): Sleep complaints increase significantly with age in both men and women, but the increase is especially striking in women. Older women experience more nighttime awakenings, longer sleep onset latencies, and "lighter" sleep. Insomnia, disrupted sleep, and consequent daytime drowsiness are associated with an increased risk of accidents, increased utilization of health care and sedative-hypnotic medications, and a reduced quality of life. Older women receive a disproportionate number of prescriptions for sedative-hypnotics, which can exacerbate sleep apnea and lead to daytime carryover effects such as sedation, falls and subsequent fractures, and cognitive impairment. A better understanding of the sleep changes experienced by older women is sorely needed. One contributing factor may be agerelated changes in sex steroids such as estrogen. The very low levels of estrogen that occur post-menopause have wide-ranging chronic effects, from increased cardiovascular risk factors to possible effects on memory. Sleep changes in older women may also be related to this dramatic change in hormonal milieu. Several studies have shown that ERT can improve the sleep of peri-menopausal women, and our preliminary data shows that the use of ERT is associated with better sleep in older post-menopausal women. Estrogen acts on several brain areas important for sleep and circadian rhythms (e.g., the suprachiasmatic nucleus, the hypothalamic pre-optic area, and the pineal gland). Previous studies of ERT effects on sleep were based on peri-menopausal women who were experiencing hot flashes and/or other menopausal symptoms including depression. All but a few of these studies were based on brief subjective sleep ratings. No published studies have examined the effect of ERT on the sleep of post-menopausal women., i.e., women who are several years past menopause, menopausal symptoms, and menopause-related hormone fluctuations. The proposed study will employ laboratory-based polysomnography and a randomized, placebo-controlled withinsubjects design to assess the effect of six months ERT or placebo on the sleep and circadian rhythms of post-menopausal women. The results will help determine the role

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of age-related estrogen decline in the decreased sleep quality of older women. This study is the first step in a research program investigating the relationship between sex steroids and sleep in older individuals. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SOY & MENOPAUSAL SYMPTOMS Principal Investigator & Institution: Woods, Margo; New England Medical Center Hospitals 750 Washington St Boston, Ma 021111533 Timing: Fiscal Year 2001 Summary: A total of 120 postmenopausal women, of all races, aged between 43-58, with or without a history of breast cancer, and experiencing hot flashes or night sweats are currently being recruited for a research study. This study investigates the effects of soy protein on menopausal symptoms and hormone levels. Women are screened over the phone and if they meet the pre-screening criteria they are sent a packet of screening materials. Upon receipt of this packet the participant is called and if eligible they begin the intervention portion of the protocol. Participants are randomly assigned to consume soy or placebo bars for the duration of the intervention which is 12 weeks. During this period of intervention participants provide four blood samples (2 at the beginning and 2 at the end), two urine samples (1 at the beginning and 1 at the end of the 12 wks), hot flash logs, 3 day food records, and questionnaires throughout the 12 weeks. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: SYMPTOM MANAGEMENT IN LIFE-THREATENING ILLNESS Principal Investigator & Institution: Nail, Lillian M.; Professor; None; Oregon Health & Science University Portland, or 972393098 Timing: Fiscal Year 2001; Project Start 15-SEP-2001; Project End 31-AUG-2004 Summary: from applicant's Abstract): Symptom management is an important component of nursing practice across care settings, client populations, and type of practice. Although the value of symptom management is widely recognized, the research base supporting practice is uneven with extensive research on pain and pain management and little research addressing symptoms like constipation, thirst, itching, hot flashes in men, and fatigue in chronic heart failure. Symptom management research is quite broad in scope. It includes identification of previously uncharacterized symptoms, examination of approaches to symptom reporting, describing symptom appraisals and symptom interpretation, documenting the pattern of a specific symptom or examining the patterns of relationships among a variety of symptoms, testing interventions designed to prevent or ameliorate a symptom or those aimed at modifying responses to symptoms, and the systematic evaluation of strategies for translating knowledge about symptom management into practice. The experience of lifethreatening illness is especially relevant to the science of symptom management because symptoms are a key element of the illness experience. The aims of the proposed exploratory center are to advance the state-of-the-art for knowledge development and utilization on symptom management in life-threatening illness (cancer, cardiac disease, and end-of-life care), establish a new methodologic standard for symptom management research, develop an infrastructure to symptom management research at the OHSU SON, and enhance the existing research environment. The Center will provide funding for three pilot/feasibility studies each year for three years and provide shared resources to support these pilot studies in the areas of Statistical Analysis, Methodologic Support, and Logistical Support. The Center is built on a strong research base that includes two

18 Hot Flashes

NIH-funded R01's and additional NIH funded symptom management studies as well as foundation funded projects. The leadership team includes two senior level and one experienced mid-career scientist, all of whom address aspects of symptom management in their own programs of research. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TAMAXIFEN PHARMACOGENETICS Principal Investigator & Institution: Flockhart, David A.; Chief, Division of Clinical Pharmacology; Medicine; Indiana Univ-Purdue Univ at Indianapolis 620 Union Drive, Room 618 Indianapolis, in 462025167 Timing: Fiscal Year 2001; Project Start 01-MAY-2000; Project End 31-JUL-2004 Summary: The successful application of pharmacogenetics requires a full understanding of the expression of genotype as phenotype. A large number of genes code for proteins that mediate response to medicines, and while it is clear that variations in one gene can alter the clinical response to a medicine significantly, this is rare. We propose to study multiple genetic influences on the clinical pharmacology of an important drug: tamoxifen. Our goal is to define multiple genetic influences on the action of this drug as a model for many other drugs, where multiple genetic variations are likely to alter pharmacologic responses. An interdisciplinary group of investigators will use a pharmacogenetic and analytical core laboratory and the resources of the Lombardi Cancer Center to study genetic influences on the metabolism, pharmacokinetics, efficacy and toxicity of tamoxifen. While tamoxifen has been shown to be metabolized by genetically polymorphic cytochrome P450 enzymes in human liver microsomes in vitro, the hypothesis that mutations in the genes coding for these enzymes might alter the drug's metabolism, effects or toxicity has never been tested in vivo, either in normal volunteers or in women with breast cancer. We have the following specific goals: 1) Determine the variability in the contributions of three genetically polymorphic enzymes (CYP2C9, CYP2D6 and CYP3A) to tamoxifen metabolism in human liver microsomes and in isolated human hepatocytes; 2) Test the hypothesis that CYP2D6, CYP3A or CYP2C9 genetics alter the pharmacokinetics of tamoxifen and its metabolites in a clinical trial in patients being prescribed tamoxifen as an adjuvant; 3) Test the hypothesis that metabolic pharmacogenetics influence the efficacy of tamoxifen through analysis of tamoxifen concentrations and metabolic genotypes in patients enrolled in the NSABP-P1 trial: a comparison of the preventive efficacy of tamoxifen and placebo; and 4) Test the hypothesis that genetics alter the toxicity of tamoxifen by A) testing the hypothesis that genetic polymorphisms that influence the metabolism of tamoxifen change the incidence of hot flashes that occur after administration of the drug., and B) testing whether the adverse effects of tamoxifen on cardiac QT interval are influenced by genetic polymorphisms in metabolism and/or ion channels. The multiple pharmacogenetic influences on these measures of tamoxifen effect will be analyzed to determine the pharmacogenetic profile of subjects most likely to experience efficacy, or to experience adverse effects from tamoxifen. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: THE YUCATAN MICROPIG CARDIOVASCULAR MODEL OF MENOPAUSE Principal Investigator & Institution: Goodrich, James A.; Comparative Medicine; Medical University of South Carolina 171 Ashley Ave Charleston, Sc 29425 Timing: Fiscal Year 2002; Project Start 01-JUN-2002; Project End 31-MAY-2007

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Summary: (provided by applicant): Menopause in women is an understudied normal aspect of the aging process that is associated with a loss of estrogen production and increased risk of cardiovascular disease and other health problems. Estrogen is generally considered to be cardioprotective. There are currently unprecedented numbers of women, about 50 million, in the United States reaching menopause; cardiovascular disease is the number one killer of postmenopausal women. Animal models provide a means of performing critical studies of the biological mechanisms and responses to existing and emerging therapies for this condition (i.e. soy protein/isoflavones). A nonprimate animal model of menopause is needed to provide a research tool that is: 1) readily available to many researchers; 2) low in risk for zoonotic disease; 3) domesticated; 4) a low cost rapidly renewable resource; 5) possess a similar coronary artery anatomy; and 6) atherosclerotic lesion to that of women. The ovariectomized Yucatan Micropig has the potential to fill this void, and will serve the interests of both the NIA and NHLBI. The overall objective of this application is to develop, characterize, and improve the Yucatan Micropig Model of Menopause for use in cardiovascular studies. This will be approached by Aim 1 clarifying the cardioprotective effects of soy protein in this model by measuring the extent of the reduction in coronary artery atherosclerosis, serum lipids, inflammatory risk factors (C-reactive Protein, Interleukin6) and blood pressure among soy, control, and conjugated equine estrogen treated groups. Establishing that soy protein can reduce coronary artery atherosclerosis in Micropigs, like it does in monkeys, would provide foundation data helpful to future soy isoflavone mechanistic studies in the Micropig model. Studies to determine how soy isoflavones and soy protein interact to reduce serum cholesterol and subsequently coronary artery atherosclerosis are needed. The next step is Aim 2, to examine the effects of these treatments on reproductive tissue. The investigators approach this aim by comparing uterine weights, and mammary and uterine immunohistology among these groups. The third step Aim 3, is to determine if and to what extent there is a natural female cardioprotection in the Yucatan Micropig. The investigators will approach this by comparing groups of male, ovariectomized female, and intact female Micropigs fed an atherogenic diet. The end points will be identical to those of the first aim. Finally, Aim 4, is to determine if and to what extent ovariectomized female Yucatan Micropigs experience vasomotor symptoms or hot flashes related to estrogen deficiency. This will be approached through continuous telemetric monitoring of skin temperature spikes before and after ovariectomy and then with and without estrogen replacement therapy. The future plans for this model are to use it to study the cardiovascular benefits/risks of new progestins, selective estrogen receptor modulators, tissue selective estrogens, and isoflavone products, as well as the mechanism by which soy protein lowers serum cholesterol and coronary artery atherosclerosis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: URINARY EXCRETION OF DEOXYPYRIDINOLINE CROSSLINKS AND N-TELOPEPTIDES Principal Investigator & Institution: Phelps, John; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2001 Summary: The purpose of this study is to investigate the influence of low dose oral contraceptives on bone resorption in perimenopausal women as determined by urinary markers of bone metabolism. Twenty healthy perimenopausal women will be enrolled. The perimenopausal women will meet all inclusion criteria prior to enrollment. Inclusion criteria Will include 1) age between 45-50 years, 2) change in menstrual cycle

20 Hot Flashes

interval, 3) complaints of hot flashes, 4) elevated follicular or luteal phase FSH and 5) serum creatinine < 1.5 mg/dI. Patients who have been longer than 6 months without a menstrual cycle or have taken hormonal therapy within the preceding 6 months will be excluded. In addition, women who smoke, have a history of taking bisphosphonates, calcitonin, or calcitriol, or who have a history of parathyroid disease will be excluded. Two baseline urine specimens from the first morning void will be collected on two separate days from patients enrolled in the study. Urinary concentrations of deoxypyridinoline crosslinks will be measured using Pyrlinks-D (Metra Biosystems, Mountain View, CA) enzyme-linked immunoassay. Urinary concentrations of Ntelopeptides will be measures using Osteomark (Ostex, Seattle, WA) enzyme-linked immunoassay. Concentrations of deoxypyridinoline crosslinks and N-telopeptides from the two baseline urine specimens will be averaged to determine the baseline excretion prior to initiating hormonal therapy. Patients will then be given Loestrin (Parke-Davis, Morris Plains, NJ), containing 20 mcg ethinyl estradiol with I mg norethindrone acetate the following Sunday. Urinary specimens obtained from the first morning void will be collected on a weekly basis for a total of four weeks after initiation of Loestrin. The urinary specimens will be assayed for both deoxypyridinoline crosslinks and Ntelopeptides. Concentrations of urinary deoxypyridinoline crosslinks and Ntelopeptides prior to and after each successive week of oral contraceptive pill use win then be compared. A one-tailed Student's t-test will be used for statistical analysis. Significance will be defined as a P value < 0.05. The power of the study is anticipated to be greater than 0.80 based on previous responses to estrogen therapy on urinary niarkers of bone metabolism. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: USE OF ANTIDEPRESSANTS AND RISK OF BREAST CANCER Principal Investigator & Institution: Rossing, Mary A.; Associate Member; Fred Hutchinson Cancer Research Center Box 19024, 1100 Fairview Ave N Seattle, Wa 98109 Timing: Fiscal Year 2002; Project Start 13-FEB-2002; Project End 31-JAN-2004 Summary: (provided by applicant): Diagnosis of depression is increasing in the United States, and women are twice as likely as men to suffer from depressive symptoms. With the advent of the selective serotonin reuptake inhibitors (SSRIs), antidepressant use has increased dramatically during the 1980s and 1990s, and the types of antidepressants prescribed have changed. Recent evidence that antidepressants can reduce the occurrence of menopausal hot flashes has led to predictions that antidepressant use may increase still further, particularly among women who are reluctant to take hormone replacement therapy due to concerns about breast cancer risk. Thus, better understanding of any possible role of antidepressants in breast cancer etiology is of substantial and growing public health importance. Initial concern about a role of antidepressants in human carcinogenesis was sparked by reports of increased occurrence of mammary tumors in rats administered tricyclic antidepressants or SSRIs. Epidemiologic findings have been inconsistent, but have not dispelled this concern. Two recent studies reported an elevated risk of breast cancer among users of some antidepressants; however, the class or type of antidepressant associated with increased risk differed. These studies were limited by the potential for error in self-reported drug use, and by relatively small numbers of exposed women. We propose to conduct a population-based, case control study to examine the association between antidepressant use and risk of breast cancer within the Group Health Cooperative of Puget Sound (GHC). Approximately 3,652 women diagnosed with first primary breast cancer (3,080 with invasive disease) during 1990-2000 and 7,304 randomly selected, matched controls

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will be included. Antidepressant use will be ascertained through the GHC pharmacy database, and information on potential confounding factors will be obtained from risk factor surveys routinely administered by GHC. The large study size and broad, recent interval of diagnosis years of cases will allow examination of the type, timing, and duration of use of antidepressants overall, classes of drugs (e.g., SSRIs or tricyclics), and individual drugs such as fluoxetine and paroxetine. Use of the pharmacy database will provide unbiased and complete exposure data relative to previous studies based on selfreported drug use. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: VENLAFAXINE FOR HOT FLASHES FOLLOWING BREAST CANCER Principal Investigator & Institution: Carpenter, Janet S.; None; Vanderbilt University 3319 West End Ave. Nashville, Tn 372036917 Timing: Fiscal Year 2001; Project Start 01-SEP-2000; Project End 31-MAY-2004 Summary: Hot flashes are the most severe and fourth most prevalent menopausal symptom reported by women with breast cancer. Hot flashes affect over 65 percent of this population, with 59 percent rating the symptom as severe and 44 percent reporting they are extremely distressed by the symptom. Despite the high prevalence, severity and distress associated with this symptom, the scientific basis for managing hot flashes in women with breast cancer is limited. This randomized, double-blind, placebo-controlled crossover trial examines the effectiveness and toxicity of sustained release venlafaxine hydrochloride (37.5 mg po qd) on hot flashes in women following treatment for breast cancer. Venlafaxine is a phenylethylamine derivative that potently inhibits the reuptake of neuronal serotonin and norepinephrine and weakly inhibits the reuptake of dopamine. A secondary aim of this project is to examine the impact of hot flashes on psychological, behavioral, and physical outcomes. This study is based on the Wickham Symptom Management Model which depicts interrelationships between symptoms, symptom management strategies, and symptom management outcomes. Participants (n = 80) who are at least one month post-completion of surgery, radiation, and/or chemotherapy and who have been on tamoxifen (if prescribed) for at least 6 weeks will complete a 2-week baseline hot flash assessment and be randomized to one arm of the crossover trial. At the end of the first 6-week arm, participants will crossover to the opposite study arm for an additional 6 weeks. Outcomes to be assessed include effectiveness of the intervention (hot flash frequency, severity, distress and magnitude), toxicity of the intervention (subjective preference, side effects), psychological outcomes (mood disturbance), behavioral outcomes (quality of life, interference with daily activities) and physical outcomes (fatigue and sleep disturbance). Hot flashes will be measured daily, using a subjective, prospective diary methodology, and weekly, using objective state-of-the art 24-hour physiological monitoring of sternal skin conductance. Other outcomes will be measured weekly. Compliance with the intervention/placebo will be assessed weekly using medication blister pack cards. Timing of outcome assessments is based on limitations of the physiological monitoring device and expected timing of treatment effects. Summary statistics (i.e., mean, slope, maximum response, range, proportion, achievable difference) will be used to effectively reduce the design to a 2 X 2 crossover and data will be analyzed accordingly (i.e., t-tests, linear regression, GEE, mixed model). Study findings will significantly contribute to the scientific basis of hot flash management in women following treatment for breast cancer. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

22 Hot Flashes

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

A pilot trial assessing the efficacy of paroxetine hydrochloride (Paxil) in controlling hot flashes in breast cancer survivors. Author(s): Stearns V, Isaacs C, Rowland J, Crawford J, Ellis MJ, Kramer R, Lawrence W, Hanfelt JJ, Hayes DF. Source: Annals of Oncology : Official Journal of the European Society for Medical Oncology / Esmo. 2000 January; 11(1): 17-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10690382&dopt=Abstract

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A pilot trial of paroxetine for the treatment of hot flashes and associated symptoms in women with breast cancer. Author(s): Weitzner MA, Moncello J, Jacobsen PB, Minton S. Source: Journal of Pain and Symptom Management. 2002 April; 23(4): 337-45. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11997203&dopt=Abstract

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A qualitative approach to defining “hot flashes” in men. Author(s): Quella S, Loprinzi CL, Dose AM. Source: Urologic Nursing : Official Journal of the American Urological Association Allied. 1994 December; 14(4): 155-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7817208&dopt=Abstract

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

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Ask the doctor. I've been taking estrogen since I reached menopause seven years ago, and it really helped my hot flashes and other symptoms. When I started these drugs, I was told they would lower my risk for osteoporosis and heart attacks, but I ve been reading lots of negative articles about how they may increase risk for heart problems. Should I stop them? Author(s): Lee TH. Source: Harvard Heart Letter : from Harvard Medical School. 2001 October; 12(2): 7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11684494&dopt=Abstract

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Ask the doctor. I've been taking tamoxifen for several months after completing treatment for breast cancer. My doctor prescribed it primarily to lower my risk of developing cancer in my unaffected breast. As a result of chemotherapy, I underwent menopause abruptly. Tamoxifen has worsened my symptoms, especially hot flashes and vaginal dryness. Other than stopping the tamoxifen, are there ways to deal with the side effects? Author(s): Nicholson CR. Source: Harvard Women's Health Watch. 1999 May; 6(9): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10198465&dopt=Abstract

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Biochemical, metabolic, and vascular mechanisms in menopausal hot flashes. Author(s): Freedman RR. Source: Fertility and Sterility. 1998 August; 70(2): 332-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9696230&dopt=Abstract

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Biophysical and endocrine-metabolic changes during menopausal hot flashes: increase in plasma free fatty acid and norepinephrine levels. Author(s): Cignarelli M, Cicinelli E, Corso M, Cospite MR, Garruti G, Tafaro E, Giorgino R, Schonauer S. Source: Gynecologic and Obstetric Investigation. 1989; 27(1): 34-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2920971&dopt=Abstract

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Body temperatures during menopausal hot flashes. Author(s): Molnar GW. Source: Journal of Applied Physiology (Bethesda, Md. : 1985). 1975 March; 38(3): 499503. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1150563&dopt=Abstract

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By the way, doctor. I'm one year into menopause and really bothered by hot flashes and vaginal dryness. I'd like to take hormone replacement therapy, but I'm worried about increasing my risk of getting breast cancer. My doctor said I can take HRT at a dose longer than what's usually prescribed. What do you think? Author(s): Robb-Nicholson C. Source: Harvard Women's Health Watch. 2001 September; 9(1): 7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11572838&dopt=Abstract

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By the way, doctor. I don't know whether to start hormone-replacement therapy. I'm having a terrible time with hot flashes, but I'm worried about the risk for ovarian and breast cancer. What should I do? Author(s): Lee TH. Source: Harvard Health Letter / from Harvard Medical School. 2001 June; 26(8): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11439435&dopt=Abstract

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Changes in neurotensin-like immunoreactivity during menopausal hot flashes. Author(s): Kronenberg F, Carraway RE. Source: The Journal of Clinical Endocrinology and Metabolism. 1985 June; 60(6): 1081-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3998060&dopt=Abstract

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Characterization of hot flashes reported by healthy postmenopausal women receiving raloxifene or placebo during osteoporosis prevention trials. Author(s): Cohen FJ, Lu Y. Source: Maturitas. 2000 January 15; 34(1): 65-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10687884&dopt=Abstract

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Cimetidine and hot flashes. Author(s): Shuster J. Source: Nursing. 2000 February; 30(2): 68. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11000844&dopt=Abstract

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Circadian rhythm of objectively recorded hot flashes in postmenopausal breast cancer survivors. Author(s): Carpenter JS, Gautam S, Freedman RR, Andrykowski M. Source: Menopause (New York, N.Y.). 2001 May-June; 8(3): 181-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11355040&dopt=Abstract

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Circadian rhythms in hot flashes in natural and surgically-induced menopause. Author(s): Albright DL, Voda AM, Smolensky MH, Hsi B, Decker M. Source: Chronobiology International. 1989; 6(3): 279-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2805156&dopt=Abstract

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Core body temperature and circadian rhythm of hot flashes in menopausal women. Author(s): Freedman RR, Norton D, Woodward S, Cornelissen G. Source: The Journal of Clinical Endocrinology and Metabolism. 1995 August; 80(8): 2354-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7629229&dopt=Abstract

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Correlates of menopausal hot flashes. Author(s): Gannon L, Hansel S, Goodwin J. Source: Journal of Behavioral Medicine. 1987 June; 10(3): 277-85. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3612784&dopt=Abstract

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Cyproterone acetate for treatment of hot flashes after orchiectomy. Author(s): Moon TD. Source: The Journal of Urology. 1985 July; 134(1): 155-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3159912&dopt=Abstract

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Definitions of hot flashes in breast cancer survivors. Author(s): Finck G, Barton DL, Loprinzi CL, Quella SK, Sloan JA. Source: Journal of Pain and Symptom Management. 1998 November; 16(5): 327-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9846028&dopt=Abstract

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Depomedroxyprogesterone acetate for hot flashes. Author(s): Barton D, Loprinzi C, Quella S, Sloan J, Pruthi S, Novotny P. Source: Journal of Pain and Symptom Management. 2002 December; 24(6): 603-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12551811&dopt=Abstract

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Differential diagnosis of hot flashes. Author(s): Mohyi D, Tabassi K, Simon J. Source: Maturitas. 1997 July; 27(3): 203-14. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9288692&dopt=Abstract

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Do menopausal hot flashes have any significant effects on arterial blood gas measurements? Author(s): Aktan E, Kaleli B, Sungurtekin H. Source: Maturitas. 1998 June 17; 29(3): 225-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9699193&dopt=Abstract

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Effect of clonidine on hot flashes in postmenopausal women. Author(s): Laufer LR, Erlik Y, Meldrum DR, Judd HL. Source: Obstetrics and Gynecology. 1982 November; 60(5): 583-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7145250&dopt=Abstract

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Effect of fever on menopausal hot flashes. Author(s): Barnard RM, Kronenberg F, Downey JA. Source: Maturitas. 1992 March; 14(3): 181-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1508059&dopt=Abstract

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Elevations in skin temperature of the finger as an objective index of postmenopausal hot flashes: standardization of the technique. Author(s): Meldrum DR, Shamonki IM, Frumar AM, Tataryn IV, Chang RJ, Judd HL. Source: American Journal of Obstetrics and Gynecology. 1979 November 15; 135(6): 7137. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=495671&dopt=Abstract

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Estrogen levels in postmenopausal women with hot flashes. Author(s): Erlik Y, Meldrum DR, Judd HL. Source: Obstetrics and Gynecology. 1982 April; 59(4): 403-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7078891&dopt=Abstract

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Estrogen raises the sweating threshold in postmenopausal women with hot flashes. Author(s): Freedman RR, Blacker CM. Source: Fertility and Sterility. 2002 March; 77(3): 487-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11872200&dopt=Abstract

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Further delineation of hypothalamic dysfunction responsible for menopausal hot flashes. Author(s): Gambone J, Meldrum DR, Laufer L, Chang RJ, Lu JK, Judd HL. Source: The Journal of Clinical Endocrinology and Metabolism. 1984 December; 59(6): 1097-102. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6436285&dopt=Abstract

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Gabapentin for hot flashes in prostate cancer. Author(s): Jeffery SM, Pepe JJ, Popovich LM, Vitagliano G. Source: The Annals of Pharmacotherapy. 2002 March; 36(3): 433-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11895055&dopt=Abstract

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Gabapentin's effects on hot flashes and hypothermia. Author(s): Guttuso TJ Jr. Source: Neurology. 2000 June 13; 54(11): 2161-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10851385&dopt=Abstract

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Gabapentin's effects on hot flashes in postmenopausal women: a randomized controlled trial. Author(s): Guttuso T Jr, Kurlan R, McDermott MP, Kieburtz K. Source: Obstetrics and Gynecology. 2003 February; 101(2): 337-45. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12576259&dopt=Abstract

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Hot flashes and related outcomes in breast cancer survivors and matched comparison women. Author(s): Carpenter JS, Johnson D, Wagner L, Andrykowski M. Source: Oncology Nursing Forum. 2002 April; 29(3): E16-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11979290&dopt=Abstract

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Hot flashes and sweats in men with testicular insufficiency. Author(s): Feldman JM, Postlethwaite RW, Glenn JF. Source: Archives of Internal Medicine. 1976 May; 136(5): 606-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1267566&dopt=Abstract

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Hot flashes and their management in breast cancer. Author(s): Carpenter JS. Source: Semin Oncol Nurs. 2000 August; 16(3): 214-25. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10967794&dopt=Abstract

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Hot flashes in men with testicular insufficiency. Author(s): Norcross WA, Schmidt JD. Source: The Western Journal of Medicine. 1986 October; 145(4): 515-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3788136&dopt=Abstract

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Hot flashes in patients with hypogonadism and low serum gonadotropin levels. Author(s): Gordon DL, Emanuele MA. Source: Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. 2003 March-April; 9(2): 11923. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12917073&dopt=Abstract

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Hot flashes in postmenopausal women ameliorated by danazol. Author(s): Foster GV, Zacur HA, Rock JA. Source: Fertility and Sterility. 1985 March; 43(3): 401-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3979577&dopt=Abstract

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Hot flashes in postmenopausal women treated for breast carcinoma: prevalence, severity, correlates, management, and relation to quality of life. Author(s): Carpenter JS, Andrykowski MA, Cordova M, Cunningham L, Studts J, McGrath P, Kenady D, Sloan D, Munn R. Source: Cancer. 1998 May 1; 82(9): 1682-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9576289&dopt=Abstract

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Hot flashes in the late reproductive years: risk factors for Africa American and Caucasian women. Author(s): Freeman EW, Sammel MD, Grisso JA, Battistini M, Garcia-Espagna B, Hollander L. Source: Journal of Women's Health & Gender-Based Medicine. 2001 January-February; 10(1): 67-76. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11224946&dopt=Abstract

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Hot flashes in the operating room. Author(s): Rockoff MA. Source: Anesthesiology. 1978 November; 49(5): 377-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=736300&dopt=Abstract

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Hot flashes revisited. Author(s): Freedman RR. Source: Menopause (New York, N.Y.). 2000 January-February; 7(1): 3-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10646697&dopt=Abstract

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Hot flashes: aetiology and management. Author(s): Barton D, Loprinzi C, Wahner-Roedler D. Source: Drugs & Aging. 2001; 18(8): 597-606. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11587246&dopt=Abstract

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Hot flashes: epidemiology and physiology. Author(s): Kronenberg F. Source: Annals of the New York Academy of Sciences. 1990; 592: 52-86; Discussion 12333. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2197954&dopt=Abstract

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Hot flashes: phenomenology, quality of life, and search for treatment options. Author(s): Kronenberg F. Source: Experimental Gerontology. 1994 May-August; 29(3-4): 319-36. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7925752&dopt=Abstract

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Hot flashes: the old and the new, what is really true? Author(s): Fitzpatrick LA, Santen RJ. Source: Mayo Clinic Proceedings. 2002 November; 77(11): 1155-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12440549&dopt=Abstract

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How to manage hot flashes in prostate cancer? Author(s): Baum N. Source: Postgraduate Medicine. 2003 May; 113(5): 4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12764891&dopt=Abstract

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I had a hysterectomy and my ovaries were also removed in 1986, when I was 46. After combinations of estrogen in tablets and patches failed to relieve my hot flashes, my doctor tried monthly estrogen injections. They controlled my symptoms beautifully, and I have been taking them ever since. I have not been able to find much information about estrogen injections. is there any harm in taking the hormone this way? Author(s): Robb-Nicholson C. Source: Harvard Women's Health Watch. 1999 March; 6(7): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10066323&dopt=Abstract

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Impact of hot flashes on quality of life among postmenopausal women being treated for breast cancer. Author(s): Stein KD, Jacobsen PB, Hann DM, Greenberg H, Lyman G. Source: Journal of Pain and Symptom Management. 2000 June; 19(6): 436-45. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10908824&dopt=Abstract

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Induction of hot flashes in premenopausal women treated with a long-acting GnRH agonist. Author(s): DeFazio J, Meldrum DR, Laufer L, Vale W, Rivier J, Lu JK, Judd HL. Source: The Journal of Clinical Endocrinology and Metabolism. 1983 March; 56(3): 445-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6401756&dopt=Abstract

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Intramuscular depot medroxyprogesterone versus oral megestrol for the control of postmenopausal hot flashes in breast cancer patients: a randomized study. Author(s): Bertelli G, Venturini M, Del Mastro L, Bergaglio M, Sismondi P, Biglia N, Venturini S, Porcile G, Pronzato P, Costantini M, Rosso R. Source: Annals of Oncology : Official Journal of the European Society for Medical Oncology / Esmo. 2002 June; 13(6): 883-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12123333&dopt=Abstract

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Investigation of hot flashes by ambulatory monitoring. Author(s): Molnar GW. Source: The American Journal of Physiology. 1979 November; 237(5): R306-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=495780&dopt=Abstract

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Laboratory and ambulatory monitoring of menopausal hot flashes. Author(s): Freedman RR. Source: Psychophysiology. 1989 September; 26(5): 573-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2616704&dopt=Abstract

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Long term use of megestrol acetate by cancer survivors for the treatment of hot flashes. Author(s): Quella SK, Loprinzi CL, Sloan JA, Vaught NL, DeKrey WL, Fischer T, Finck G, Pierson N, Pisansky T. Source: Cancer. 1998 May 1; 82(9): 1784-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9576302&dopt=Abstract

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Low-dose hormone replacement therapy for hot flashes. Author(s): Mikhail N. Source: Mayo Clinic Proceedings. 2003 March; 78(3): 379; Author Reply 379. Erratum In: Mayo Clin Proc. 2003 May; 78(5): 656. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12630592&dopt=Abstract

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Managing hot flashes after breast cancer. Author(s): Carpenter JS, Lambert B. Source: Oncology Nursing Forum. 2000 January-February; 27(1): 23-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10660914&dopt=Abstract

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Measurement of hot flashes by sternal skin conductance and subjective hot flash report in Puebla, Mexico. Author(s): Sievert LL, Freedman RR, Garcia JZ, Foster JW, del Carmen Romano Soriano M, Longcope C, Franz C. Source: Menopause (New York, N.Y.). 2002 September-October; 9(5): 367-76. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12218726&dopt=Abstract

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Megestrol acetate for the prevention of hot flashes. Author(s): Hughes-Davies TH. Source: The New England Journal of Medicine. 1995 January 5; 332(1): 64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7864968&dopt=Abstract

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Megestrol acetate for the prevention of hot flashes. Author(s): Loprinzi CL, Michalak JC, Quella SK, O'Fallon JR, Hatfield AK, Nelimark RA, Dose AM, Fischer T, Johnson C, Klatt NE, et al. Source: The New England Journal of Medicine. 1994 August 11; 331(6): 347-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8028614&dopt=Abstract

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Menopausal hot flash frequency changes in response to experimental manipulation of blood glucose. Author(s): Dormire SL, Reame NK. Source: Nursing Research. 2003 September-October; 52(5): 338-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14501548&dopt=Abstract

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Menopausal hot flashes and osteoporosis. Author(s): Voda AM. Source: The Nurse Practitioner. 1987 November; 12(11): 60-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3696539&dopt=Abstract

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Menopausal hot flashes: their cycles and relation to air temperature. Author(s): Molnar GW. Source: Obstetrics and Gynecology. 1981 June; 57(6 Suppl): 52S-5S. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7243124&dopt=Abstract

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Menopausal hot flashes: thermoregulatory, cardiovascular, and circulating catecholamine and LH changes. Author(s): Kronenberg F, Cote LJ, Linkie DM, Dyrenfurth I, Downey JA. Source: Maturitas. 1984 July; 6(1): 31-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6472126&dopt=Abstract

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Menopausal-like hot flashes reported in women of reproductive age. Author(s): Hahn PM, Wong J, Reid RL. Source: Fertility and Sterility. 1998 November; 70(5): 913-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9806575&dopt=Abstract

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Moclobemide in the treatment of hot flashes in postmenopausal women. Author(s): Tarim E, Bagis T, Kilicdag E, Erkanli S, Aslan E, Kuscu E. Source: Adv Ther. 2002 November-December; 19(6): 258-65. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12665046&dopt=Abstract

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Momentary increase in plasma calcitonin gene-related peptide is involved in hot flashes in men treated with castration for carcinoma of the prostate. Author(s): Spetz AC, Pettersson B, Varenhorst E, Theodorsson E, Thorell LH, Hammar M. Source: The Journal of Urology. 2001 November; 166(5): 1720-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11586209&dopt=Abstract

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Nonhormonal agents show promise against hot flashes. Author(s): Gottlieb N. Source: Journal of the National Cancer Institute. 2000 July 19; 92(14): 1118-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10904081&dopt=Abstract

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Obesity and fat distribution in relation to hot flashes in Dutch women from the DOM-project. Author(s): den Tonkelaar I, Seidell JC, van Noord PA. Source: Maturitas. 1996 April; 23(3): 301-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8794424&dopt=Abstract

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Objective techniques for the assessment of postmenopausal hot flashes. Author(s): Tataryn IV, Lomax P, Meldrum DR, Bajorek JG, Chesarek W, Judd HL. Source: Obstetrics and Gynecology. 1981 March; 57(3): 340-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7465149&dopt=Abstract

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Oral clonidine in postmenopausal patients with breast cancer experiencing tamoxifen-induced hot flashes: a University of Rochester Cancer Center Community Clinical Oncology Program study. Author(s): Pandya KJ, Raubertas RF, Flynn PJ, Hynes HE, Rosenbluth RJ, Kirshner JJ, Pierce HI, Dragalin V, Morrow GR. Source: Annals of Internal Medicine. 2000 May 16; 132(10): 788-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10819701&dopt=Abstract

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Paroxetine controlled release in the treatment of menopausal hot flashes: a randomized controlled trial. Author(s): Stearns V, Beebe KL, Iyengar M, Dube E. Source: Jama : the Journal of the American Medical Association. 2003 June 4; 289(21): 2827-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12783913&dopt=Abstract

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Pathological hyperprolactinemia suppresses hot flashes in menopausal women. Author(s): Scoccia B, Schneider AB, Marut EL, Scommegna A. Source: The Journal of Clinical Endocrinology and Metabolism. 1988 April; 66(4): 868-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3346363&dopt=Abstract

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Phase III evaluation of fluoxetine for treatment of hot flashes. Author(s): Loprinzi CL, Sloan JA, Perez EA, Quella SK, Stella PJ, Mailliard JA, Halyard MY, Pruthi S, Novotny PJ, Rummans TA. Source: Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 2002 March 15; 20(6): 1578-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11896107&dopt=Abstract

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Physiology of hot flashes. Author(s): Freedman RR. Source: American Journal of Human Biology : the Official Journal of the Human Biology Council. 2001 July-August; 13(4): 453-64. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11400216&dopt=Abstract

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Pilot evaluation of gabapentin for treating hot flashes. Author(s): Loprinzi L, Barton DL, Sloan JA, Zahasky KM, Smith de AR, Pruthi S, Novotny PJ, Perez EA, Christensen BJ. Source: Mayo Clinic Proceedings. 2002 November; 77(11): 1159-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12440550&dopt=Abstract

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Pilot evaluation of venlafaxine for the treatment of hot flashes in men undergoing androgen ablation therapy for prostate cancer. Author(s): Quella SK, Loprinzi CL, Sloan J, Novotny P, Perez EA, Burch PA, Antolak SJ Jr, Pisansky TM. Source: The Journal of Urology. 1999 July; 162(1): 98-102. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10379749&dopt=Abstract

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Pilot evaluation of venlafaxine hydrochloride for the therapy of hot flashes in cancer survivors. Author(s): Loprinzi CL, Pisansky TM, Fonseca R, Sloan JA, Zahasky KM, Quella SK, Novotny PJ, Rummans TA, Dumesic DA, Perez EA. Source: Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 1998 July; 16(7): 2377-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9667254&dopt=Abstract

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Predictors of menopausal hot flashes. Author(s): Staropoli CA, Flaws JA, Bush TL, Moulton AW. Source: Journal of Women's Health / the Official Publication of the Society for the Advancement of Women's Health Research. 1998 November; 7(9): 1149-55. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9861592&dopt=Abstract

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Progressive prostate cancer associated with use of megestrol acetate administered for control of hot flashes. Author(s): Sartor O, Eastham JA. Source: Southern Medical Journal. 1999 April; 92(4): 415-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10219363&dopt=Abstract

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Prospective evaluation of hot flashes during treatment with parenteral estrogen or complete androgen ablation for metastatic carcinoma of the prostate. Author(s): Spetz AC, Hammar M, Lindberg B, Spangberg A, Varenhorst E; Scandinavian Prostatic Cancer Group-5 Trial Study. Source: The Journal of Urology. 2001 August; 166(2): 517-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11458057&dopt=Abstract

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Prospective evaluation of vitamin E for hot flashes in breast cancer survivors. Author(s): Barton DL, Loprinzi CL, Quella SK, Sloan JA, Veeder MH, Egner JR, Fidler P, Stella PJ, Swan DK, Vaught NL, Novotny P. Source: Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 1998 February; 16(2): 495-500. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9469333&dopt=Abstract

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Racial differences in menopause information and the experience of hot flashes. Author(s): Grisso JA, Freeman EW, Maurin E, Garcia-Espana B, Berlin JA. Source: Journal of General Internal Medicine : Official Journal of the Society for Research and Education in Primary Care Internal Medicine. 1999 February; 14(2): 98-103. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10051780&dopt=Abstract

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Reduced thermoregulatory null zone in postmenopausal women with hot flashes. Author(s): Freedman RR, Krell W. Source: American Journal of Obstetrics and Gynecology. 1999 July; 181(1): 66-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10411797&dopt=Abstract

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Relationships among sexual behavior, hot flashes, and hormone levels in perimenopausal women. Author(s): McCoy N, Culter W, Davidson JM. Source: Archives of Sexual Behavior. 1985 October; 14(5): 385-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4062536&dopt=Abstract

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Risk factors for hot flashes in midlife women. Author(s): Whiteman MK, Staropoli CA, Benedict JC, Borgeest C, Flaws JA. Source: Journal of Women's Health (2002). 2003 June; 12(5): 459-72. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12869293&dopt=Abstract

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Risk factors for menopausal hot flashes. Author(s): Schwingl PJ, Hulka BS, Harlow SD. Source: Obstetrics and Gynecology. 1994 July; 84(1): 29-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8008318&dopt=Abstract

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Sertraline relieves hot flashes secondary to medical castration as treatment of advanced prostate cancer. Author(s): Roth AJ, Scher HI. Source: Psycho-Oncology. 1998 March-April; 7(2): 129-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9589512&dopt=Abstract

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Smoking, body mass, and hot flashes in midlife women. Author(s): Whiteman MK, Staropoli CA, Langenberg PW, McCarter RJ, Kjerulff KH, Flaws JA. Source: Obstetrics and Gynecology. 2003 February; 101(2): 264-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12576249&dopt=Abstract

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Tamoxifen-induced hot flashes. Author(s): Loprinzi CL, Zahasky KM, Sloan JA, Novotny PJ, Quella SK. Source: Clinical Breast Cancer. 2000 April; 1(1): 52-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11899390&dopt=Abstract

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Temporal patterns of hot flashes in natural and surgically-induced menopause. Author(s): Albright DL, Voda AM, Smolensky MH, Hsi B, Decker M. Source: Prog Clin Biol Res. 1990; 341A: 731-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2217292&dopt=Abstract

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The effects of naloxone on hot flashes and gonadotropin secretion in postmenopausal women. Author(s): DeFazio J, Verheugen C, Chetkowski R, Nass T, Judd HL, Meldrum DR. Source: The Journal of Clinical Endocrinology and Metabolism. 1984 March; 58(3): 57881. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6420445&dopt=Abstract

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The Hot Flash Related Daily Interference Scale: a tool for assessing the impact of hot flashes on quality of life following breast cancer. Author(s): Carpenter JS. Source: Journal of Pain and Symptom Management. 2001 December; 22(6): 979-89. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11738160&dopt=Abstract

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The thermoregulatory effects of menopausal hot flashes on sleep. Author(s): Woodward S, Freedman RR. Source: Sleep. 1994 September; 17(6): 497-501. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7809562&dopt=Abstract

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Thermoregulatory physiology of menopausal hot flashes: a review. Author(s): Kronenberg F, Downey JA. Source: Canadian Journal of Physiology and Pharmacology. 1987 June; 65(6): 1312-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3304594&dopt=Abstract

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Transdermal clonidine for ameliorating post-orchiectomy hot flashes. Author(s): Loprinzi CL, Goldberg RM, O'Fallon JR, Quella SK, Miser AW, Mynderse LA, Brown LD, Tschetter LK, Wilwerding MB, Dose M, et al. Source: The Journal of Urology. 1994 March; 151(3): 634-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8308973&dopt=Abstract

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Transdermal clonidine for ameliorating tamoxifen-induced hot flashes. Author(s): Goldberg RM, Loprinzi CL, O'Fallon JR, Veeder MH, Miser AW, Mailliard JA, Michalak JC, Dose AM, Rowland KM Jr, Burnham NL. Source: Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 1994 January; 12(1): 155-8. Erratum In: J Clin Oncol 1996 August; 14(8): 2411. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8270972&dopt=Abstract

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Treatment of hot flashes with transdermal estradiol administration. Author(s): Steingold KA, Laufer L, Chetkowski RJ, DeFazio JD, Matt DW, Meldrum DR, Judd HL. Source: The Journal of Clinical Endocrinology and Metabolism. 1985 October; 61(4): 62732. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3928674&dopt=Abstract

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Treatment of menopausal hot flashes with transdermal administration of clonidine. Author(s): Nagamani M, Kelver ME, Smith ER. Source: American Journal of Obstetrics and Gynecology. 1987 March; 156(3): 561-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3826200&dopt=Abstract

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Treatment of post-orchiectomy hot flashes with transdermal administration of clonidine. Author(s): Parra RO, Gregory JG. Source: The Journal of Urology. 1990 April; 143(4): 753-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2313799&dopt=Abstract

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Use of clonidine to treat hot flashes secondary to leuprolide or goserelin. Author(s): Bressler LR, Murphy CM, Shevrin DH, Warren RF. Source: The Annals of Pharmacotherapy. 1993 February; 27(2): 182-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8439695&dopt=Abstract

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Venlafaxine for the control of hot flashes: results of a longitudinal continuation study. Author(s): Barton D, La VB, Loprinzi C, Novotny P, Wilwerding MB, Sloan J. Source: Oncology Nursing Forum. 2002 January-February; 29(1): 33-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11817491&dopt=Abstract

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Venlafaxine in management of hot flashes in survivors of breast cancer: a randomised controlled trial. Author(s): Loprinzi CL, Kugler JW, Sloan JA, Mailliard JA, LaVasseur BI, Barton DL, Novotny PJ, Dakhil SR, Rodger K, Rummans TA, Christensen BJ. Source: Lancet. 2000 December 16; 356(9247): 2059-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11145492&dopt=Abstract

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CHAPTER 2. NUTRITION AND HOT FLASHES Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and hot flashes.

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

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

40 Hot Flashes

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

A pilot study of magnetic therapy for hot flashes after breast cancer. Author(s): School of Nursing, Vanderbilt University, Nashville, Tenn 37240, USA. [email protected] Source: Carpenter, Janet S Wells, Nancy Lambert, Beth Watson, Peggy Slayton, Tami Chak, Bapsi Hepworth, Joseph T Worthington, W Bradley Cancer-Nurs. 2002 April; 25(2): 104-9 0162-220X

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Alternatives to estrogen for the treatment of hot flashes. Author(s): Department of Pharmacy Services, University of Massachusetts Medical Center, Worcester 01655, USA. Source: Lucero, M A McCloskey, W W Ann-Pharmacother. 1997 Jul-August; 31(7-8): 9157 1060-0280

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Beyond estrogen: new alternatives for the management of hot flashes. Source: Dvorak, Sonya R S-D-J-Med. 2002 January; 55(1): 11-2 0038-3317

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By the way, doctor. I'm one year into menopause and really bothered by hot flashes and vaginal dryness. I'd like to take hormone replacement therapy, but I'm worried about increasing my risk of getting breast cancer. My doctor said I can take HRT at a dose longer than what's usually prescribed. What do you think? Source: Robb Nicholson, C Harv-Womens-Health-Watch. 2001 September; 9(1): 7 1070910X

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Complementary/alternative therapies for reducing hot flashes in prostate cancer patients: reevaluating the existing indirect data from studies of breast cancer and postmenopausal women. Author(s): Department of Urology, University of Michigan Medical Center, Ann Arbor, Michigan 48109-0330, USA. [email protected] Source: Moyad, Mark A Urology. 2002 April; 59(4 Suppl 1): 20-33 1527-9995

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Effect of soy phytoestrogens on hot flashes in postmenopausal women with breast cancer: a randomized, controlled clinical trial. Author(s): British Columbia Cancer Agency, Vancouver Cancer Centre, Vancouver Hospital and Health Sciences Centre, and University of British Columbia, Vancouver, British Columbia, Canada. [email protected] Source: Van Patten, Cheri L Olivotto, Ivo A Chambers, G Keith Gelmon, Karen A Hislop, T Gregory Templeton, Edith Wattie, Angela Prior, Jerilynn C J-Clin-Oncol. 2002 March 15; 20(6): 1449-55 0732-183X

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Evaluation of soy phytoestrogens for the treatment of hot flashes in breast cancer survivors: A North Central Cancer Treatment Group Trial. Author(s): Mayo Clinic and Mayo Foundation, Rochester, USA. Source: Quella, S K Loprinzi, C L Barton, D L Knost, J A Sloan, J A LaVasseur, B I Swan, D Krupp, K R Miller, K D Novotny, P J J-Clin-Oncol. 2000 March; 18(5): 1068-74 0732183X

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Gabapentin for hot flashes in prostate cancer. Author(s): School of Pharmacy, University of Connecticut, West Haven 06156-2770, USA. [email protected] Source: Jeffery, Sean M Pepe, Jeffrey J Popovich, Lisa M Vitagliano, Gail AnnPharmacother. 2002 March; 36(3): 433-6 1060-0280

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Gabapentin's effects on hot flashes in postmenopausal women: a randomized controlled trial. Author(s): Department of Neurology, University of Rochester, Rochester, New York 14642, USA. [email protected] Source: Guttuso, T Jr Kurlan, R McDermott, M P Kieburtz, K Obstet-Gynecol. 2003 February; 101(2): 337-45 0029-7844

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I had a hysterectomy and my ovaries were also removed in 1986, when I was 46. After combinations of estrogen in tablets and patches failed to relieve my hot flashes, my doctor tried monthly estrogen injections. They controlled my symptoms beautifully, and I have been taking them ever since. I have not been able to find much information about estrogen injections. is there any harm in taking the hormone this way? Source: Robb Nicholson, C Harv-Womens-Health-Watch. 1999 March; 6(7): 8 1070-910X

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Management of hot flashes in breast-cancer survivors. Author(s): Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA. [email protected] Source: Loprinzi C, L Barton D, L Rhodes, D Lancet-Oncol. 2001 April; 2(4): 199-204 1470-2045

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Pathophysiology and treatment of hot flashes. Author(s): Department of Oncology, Mayo Clinic, Rochester, Minn 55905, USA. [email protected] Source: Shanafelt, T D Barton, D L Adjei, A A Loprinzi, C L Mayo-Clin-Proc. 2002 November; 77(11): 1207-18 0025-6196

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Pilot evaluation of gabapentin for treating hot flashes. Author(s): Division of Medical Oncology, Mayo Clinic, Rochester, Minn 55905, USA. [email protected] Source: Loprinzi, L Barton, D L Sloan, J A Zahasky, K M Smith, de AR Pruthi, S Novotny, P J Perez, E A Christensen, B J Mayo-Clin-Proc. 2002 Nov; 77(11): 1159-63 0025-6196

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Prospective evaluation of vitamin E for hot flashes in breast cancer survivors. Author(s): Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA. Source: Barton, D L Loprinzi, C L Quella, S K Sloan, J A Veeder, M H Egner, J R Fidler, P Stella, P J Swan, D K Vaught, N L Novotny, P J-Clin-Oncol. 1998 February; 16(2): 495-500 0732-183X

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Randomized trial of black cohosh for the treatment of hot flashes among women with a history of breast cancer. Author(s): Herbert Irving Comprehensive Cancer Center and Joseph L. Mailman School of Public Health, Columbia University, and Weill-Cornell Medical College, New York, NY 10032, USA. Source: Jacobson, J S Troxel, A B Evans, J Klaus, L Vahdat, L Kinne, D Lo, K M Moore, A Rosenman, P J Kaufman, E L Neugut, A I Grann, V R J-Clin-Oncol. 2001 May 15; 19(10): 2739-45 0732-183X

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Sertraline relieves hot flashes secondary to medical castration as treatment of advanced prostate cancer. Author(s): Department of Psychiatry, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. Source: Roth, A J Scher, H I Psychooncology. 1998 Mar-April; 7(2): 129-32 1057-9249

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Soy for hot flashes. Source: Tufts-Univ-health-nutr-lett. New York, NY : Tufts University Health & Nutrition Letter, c1997-. June 2001. volume 19 (4) page 7.

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Treating hot flashes with drugs. Source: Anonymous Harv-Womens-Health-Watch. 2000 August; 7(12): 7 1070-910X

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Use of clonidine to treat hot flashes secondary to leuprolide or goserelin. Author(s): Department of Pharmacy Practice, University of Illinois, Chicago 60612. Source: Bressler, L R Murphy, C M Shevrin, D H Warren, R F Ann-Pharmacother. 1993 February; 27(2): 182-5 1060-0280

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

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

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

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

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

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

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

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

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

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

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

•

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

•

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

•

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

Nutrition

•

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

•

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

•

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

•

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

43

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

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

•

Minerals Boron Source: Healthnotes, Inc.; www.healthnotes.com

•

Food and Diet Flaxseeds Source: Healthnotes, Inc.; www.healthnotes.com Soy Source: Healthnotes, Inc.; www.healthnotes.com Soy Source: Prima Communications, Inc.www.personalhealthzone.com Soy Products Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,135,00.html

45

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

A comparison of oral micronized estradiol with soy phytoestrogen effects on tail skin temperatures of ovariectomized rats. Author(s): Pan Y, Anthony MS, Binns M, Clarkson TB. Source: Menopause (New York, N.Y.). 2001 May-June; 8(3): 171-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11355038&dopt=Abstract

•

A pilot study of magnetic therapy for hot flashes after breast cancer. Author(s): Carpenter JS, Wells N, Lambert B, Watson P, Slayton T, Chak B, Hepworth JT, Worthington WB. Source: Cancer Nursing. 2002 April; 25(2): 104-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11984098&dopt=Abstract

•

A pilot study of the effects of phytoestrogen supplementation on postmenopausal endometrium. Author(s): Balk JL, Whiteside DA, Naus G, DeFerrari E, Roberts JM.

46 Hot Flashes

Source: Journal of the Society for Gynecologic Investigation. 2002 July-August; 9(4): 23842. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12113884&dopt=Abstract •

A preliminary RAPD-PCR analysis of Cimicifuga species and other botanicals used for women's health. Author(s): Xu H, Fabricant DS, Piersen CE, Bolton JL, Pezzuto JM, Fong H, Totura S, Farnsworth NR, Constantinou AI. Source: Phytomedicine : International Journal of Phytotherapy and Phytopharmacology. 2002 December; 9(8): 757-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12587700&dopt=Abstract

•

A systematic review of the safety of black cohosh. Author(s): Huntley A, Ernst E. Source: Menopause (New York, N.Y.). 2003 January-February; 10(1): 58-64. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12544678&dopt=Abstract

•

A woman attempting to discontinue hormone therapy. Author(s): Freedman RR. Source: Jama : the Journal of the American Medical Association. 2002 November 13; 288(18): 2264; Author Reply 2264-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12425696&dopt=Abstract

•

Acupuncture in the control of vasomotor symptoms caused by tamoxifen. Author(s): Towlerton G, Filshie J, O'Brien M, Duncan A. Source: Palliative Medicine. 1999 September; 13(5): 445. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10659122&dopt=Abstract

•

Acupuncture treatment of vasomotor symptoms in men with prostatic carcinoma: a pilot study. Author(s): Hammar M, Frisk J, Grimas O, Hook M, Spetz AC, Wyon Y. Source: The Journal of Urology. 1999 March; 161(3): 853-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10022700&dopt=Abstract

•

Alternative medicine and the perimenopause an evidence-based review. Author(s): Taylor M. Source: Obstetrics and Gynecology Clinics of North America. 2002 September; 29(3): 555-73. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12353674&dopt=Abstract

•

Alternative therapies for traditional disease states: menopause. Author(s): Morelli V, Naquin C.

Alternative Medicine 47

Source: American Family Physician. 2002 July 1; 66(1): 129-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12126027&dopt=Abstract •

Alternative treatments for menopausal symptoms. Systematic review of scientific and lay literature. Author(s): Seidl MM, Stewart DE. Source: Can Fam Physician. 1998 June; 44: 1299-308. Review. Erratum In: Can Fam Physician 1998 August; 44: 1598. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9640524&dopt=Abstract

•

Alternatives for women through menopause. Author(s): Gass ML, Taylor MB. Source: American Journal of Obstetrics and Gynecology. 2001 August; 185(2 Suppl): S4756. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11521122&dopt=Abstract

•

Alternatives to estrogen for the treatment of hot flashes. Author(s): Lucero MA, McCloskey WW. Source: The Annals of Pharmacotherapy. 1997 July-August; 31(7-8): 915-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9220057&dopt=Abstract

•

An integrative approach to menopause. Author(s): Dog TL, Riley D, Carter T. Source: Alternative Therapies in Health and Medicine. 2001 July-August; 7(4): 45-55; Quiz 56-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11452567&dopt=Abstract

•

Analysis of thirteen populations of black cohosh for formononetin. Author(s): Kennelly EJ, Baggett S, Nuntanakorn P, Ososki AL, Mori SA, Duke J, Coleton M, Kronenberg F. Source: Phytomedicine : International Journal of Phytotherapy and Phytopharmacology. 2002 July; 9(5): 461-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12222669&dopt=Abstract

•

Anti-osteoporotic medications: traditional and nontraditional. Author(s): Cohen DP. Source: Clinical Obstetrics and Gynecology. 2003 June; 46(2): 341-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12808384&dopt=Abstract

•

Approach to menopausal symptoms in women with breast cancer. Author(s): Stearns V, Hayes DF.

48 Hot Flashes

Source: Curr Treat Options Oncol. 2002 April; 3(2): 179-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12057081&dopt=Abstract •

Behavioral treatment of menopausal hot flashes: evaluation by objective methods. Author(s): Germaine LM, Freedman RR. Source: Journal of Consulting and Clinical Psychology. 1984 December; 52(6): 1072-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6394631&dopt=Abstract

•

Beyond estrogen: new alternatives for the management of hot flashes. Author(s): Dvorak SR. Source: S D J Med. 2002 January; 55(1): 11-2. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11808405&dopt=Abstract

•

Black cohosh acts as a mixed competitive ligand and partial agonist of the serotonin receptor. Author(s): Burdette JE, Liu J, Chen SN, Fabricant DS, Piersen CE, Barker EL, Pezzuto JM, Mesecar A, Van Breemen RB, Farnsworth NR, Bolton JL. Source: Journal of Agricultural and Food Chemistry. 2003 September 10; 51(19): 5661-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12952416&dopt=Abstract

•

Black cohosh. Author(s): Kligler B. Source: American Family Physician. 2003 July 1; 68(1): 114-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12887117&dopt=Abstract

•

Black cohosh: an alternative therapy for menopause? Author(s): Mahady GB, Fabricant D, Chadwick LR, Dietz B. Source: Nutrition in Clinical Care : an Official Publication of Tufts University. 2002 November-December; 5(6): 283-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12557811&dopt=Abstract

•

Black cohosh: efficacy, safety, and use in clinical and preclinical applications. Author(s): McKenna DJ, Jones K, Humphrey S, Hughes K. Source: Alternative Therapies in Health and Medicine. 2001 May-June; 7(3): 93-100. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11347288&dopt=Abstract

•

Botanical dietary supplement use in peri- and postmenopausal women. Author(s): Mahady GB, Parrot J, Lee C, Yun GS, Dan A. Source: Menopause (New York, N.Y.). 2003 January-February; 10(1): 65-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12544679&dopt=Abstract

Alternative Medicine 49

•

Botanicals: medicines and menopause. Author(s): Taylor M. Source: Clinical Obstetrics and Gynecology. 2001 December; 44(4): 853-63. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11600866&dopt=Abstract

•

By the way, doctor. I've started drinking soy milk instead of cow's milk because I've developed an intolerance to lactose. I know there are so-called phytoestrogens in soy products and that they are probably of some benefit to me. However, is there a problem for my husband? Author(s): Manson JE. Source: Harvard Health Letter / from Harvard Medical School. 2000 April; 25(6): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10712759&dopt=Abstract

•

Changes in heart transplant recipients that parallel the personalities of their donors. Author(s): Pearsall P, Schwartz GE, Russek LG. Source: Integr. Med. 2000 March 21; 2(2): 65-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10882878&dopt=Abstract

•

Cimicifuga extract BNO 1055: reduction of hot flushes and hints on antidepressant activity. Author(s): Winterhoff H, Spengler B, Christoffel V, Butterweck V, Lohning A. Source: Maturitas. 2003 March 14; 44 Suppl 1: S51-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12609559&dopt=Abstract

•

Cimicifuga racemosa for the treatment of hot flushes in women surviving breast cancer. Author(s): Hernandez Munoz G, Pluchino S. Source: Maturitas. 2003 March 14; 44 Suppl 1: S59-65. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12609560&dopt=Abstract

•

Complementary/alternative therapies for reducing hot flashes in prostate cancer patients: reevaluating the existing indirect data from studies of breast cancer and postmenopausal women. Author(s): Moyad MA. Source: Urology. 2002 April; 59(4 Suppl 1): 20-33. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11937433&dopt=Abstract

•

Cooling off hot flashes. Author(s): Stearns V, Hayes DF. Source: Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 2002 March 15; 20(6): 1436-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11896087&dopt=Abstract

50 Hot Flashes

•

Effect of soy phytoestrogens on hot flashes in postmenopausal women with breast cancer: a randomized, controlled clinical trial. Author(s): Van Patten CL, Olivotto IA, Chambers GK, Gelmon KA, Hislop TG, Templeton E, Wattie A, Prior JC. Source: Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 2002 March 15; 20(6): 1449-55. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11896091&dopt=Abstract

•

Evaluation of soy phytoestrogens for the treatment of hot flashes in breast cancer survivors: A North Central Cancer Treatment Group Trial. Author(s): Quella SK, Loprinzi CL, Barton DL, Knost JA, Sloan JA, LaVasseur BI, Swan D, Krupp KR, Miller KD, Novotny PJ. Source: Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 2000 March; 18(5): 1068-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10694559&dopt=Abstract

•

Hot flashes--a review of the literature on alternative and complementary treatment approaches. Author(s): Philp HA. Source: Alternative Medicine Review : a Journal of Clinical Therapeutic. 2003 August; 8(3): 284-302. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12946239&dopt=Abstract

•

Hot flashes--physiology, hormonal therapy, and alternative therapies. Author(s): Ginsburg ES. Source: Obstetrics and Gynecology Clinics of North America. 1994 June; 21(2): 381-90. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7936550&dopt=Abstract

•

Management of hot flashes in breast-cancer survivors. Author(s): Loprinzi CL, Barton DL, Rhodes D. Source: The Lancet Oncology. 2001 April; 2(4): 199-204. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11905764&dopt=Abstract

•

Menopausal hot flash and calciotonin gene-related peptide; effect of Keishi-bukuryogan, a kampo medicine, related to plasma calciotonin gene-related peptide level. Author(s): Chen JT, Shiraki M. Source: Maturitas. 2003 July 25; 45(3): 199-204. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12818465&dopt=Abstract

•

Multiple component self-control program for menopausal hot flashes. Author(s): Stevenson DW, Delprato DJ.

Alternative Medicine 51

Source: Journal of Behavior Therapy and Experimental Psychiatry. 1983 June; 14(2): 13740. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6352742&dopt=Abstract •

Objective indicator for the assessment of postmenopausal hot flashes. Author(s): Mochimaru F, Toyama M, Kanakura Y, Inde S. Source: Nippon Sanka Fujinka Gakkai Zasshi. 1984 April; 36(4): 643-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6325560&dopt=Abstract

•

Pathophysiology and treatment of hot flashes. Author(s): Shanafelt TD, Barton DL, Adjei AA, Loprinzi CL. Source: Mayo Clinic Proceedings. 2002 November; 77(11): 1207-18. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12440557&dopt=Abstract

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Phytoestrogen supplements for the treatment of hot flashes: the Isoflavone Clover Extract (ICE) Study: a randomized controlled trial. Author(s): Tice JA, Ettinger B, Ensrud K, Wallace R, Blackwell T, Cummings SR. Source: Jama : the Journal of the American Medical Association. 2003 July 9; 290(2): 20714. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12851275&dopt=Abstract

•

Randomized trial of black cohosh for the treatment of hot flashes among women with a history of breast cancer. Author(s): Jacobson JS, Troxel AB, Evans J, Klaus L, Vahdat L, Kinne D, Lo KM, Moore A, Rosenman PJ, Kaufman EL, Neugut AI, Grann VR. Source: Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 2001 May 15; 19(10): 2739-45. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11352967&dopt=Abstract

•

Soy product intake and hot flashes in Japanese women: results from a communitybased prospective study. Author(s): Nagata C, Takatsuka N, Kawakami N, Shimizu H. Source: American Journal of Epidemiology. 2001 April 15; 153(8): 790-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11296152&dopt=Abstract

•

Treating hot flashes. Author(s): McGuffey EC. Source: Am Pharm. 1995 January; Ns35(1): 14, 17. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7887369&dopt=Abstract

52 Hot Flashes

•

What we know about managing menopausal hot flashes: navigating without a compass. Author(s): Dormire SL. Source: Journal of Obstetric, Gynecologic, and Neonatal Nursing : Jognn / Naacog. 2003 July-August; 32(4): 455-64. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12903695&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/

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

The following is a specific Web list relating to hot flashes; 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 Amenorrhea Source: Integrative Medicine Communications; www.drkoop.com Bone Loss Source: Integrative Medicine Communications; www.drkoop.com Dysmenorrhea Source: Healthnotes, Inc.; www.healthnotes.com

Alternative Medicine 53

Insomnia Source: Integrative Medicine Communications; www.drkoop.com Menopausal Symptoms (other Than Osteoporosis) Source: Prima Communications, Inc.www.personalhealthzone.com Menopause Source: Healthnotes, Inc.; www.healthnotes.com Menopause Source: Integrative Medicine Communications; www.drkoop.com Osteoporosis Source: Integrative Medicine Communications; www.drkoop.com Osteoporosis Source: Prima Communications, Inc.www.personalhealthzone.com Prostate Cancer Source: Integrative Medicine Communications; www.drkoop.com Sleeplessness Source: Integrative Medicine Communications; www.drkoop.com •

Herbs and Supplements 5-htp Alternative names: 5-Hydroxytryptophan (5-HTP) Source: Integrative Medicine Communications; www.drkoop.com 5-hydroxytryptophan (5-htp) Alternative names: 5-HTP Source: Integrative Medicine Communications; www.drkoop.com Angelica Sinensis Source: Integrative Medicine Communications; www.drkoop.com Black Cohosh Alternative names: Cimicifuga racemosa Source: Healthnotes, Inc.; www.healthnotes.com Black Cohosh Alternative names: Cimicifuga racemosa (actea), Black Snakeroot Source: Integrative Medicine Communications; www.drkoop.com Black Cohosh Source: Prima Communications, Inc.www.personalhealthzone.com Black Cohosh Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10009,00.html

54 Hot Flashes

Black Snakeroot Source: Integrative Medicine Communications; www.drkoop.com Chaste Tree Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Chasteberry Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,767,00.html Chinese Angelica Source: Integrative Medicine Communications; www.drkoop.com Cimicifuga Racemosa (actea) Source: Integrative Medicine Communications; www.drkoop.com Danggui Alternative names: Angelica sinensis, Chinese Angelica, Dang Gui, Danngui, Dong Qua, Tang Kuei, Tan Kue Bai zhi(Note: Dong quai should not be confused with Angelica root or Angelica seed.) Source: Integrative Medicine Communications; www.drkoop.com Dong Quai Alternative names: Angelica sinensis Source: Healthnotes, Inc.; www.healthnotes.com Dong Quai Alternative names: Angelica sinensis, Chinese Angelica, Dang Gui, Danngui, Dong Qua, Tang Kuei, Tan Kue Bai zhi(Note: Dong quai should not be confused with Angelica root or Angelica seed.) Source: Integrative Medicine Communications; www.drkoop.com Dong Quai Source: Prima Communications, Inc.www.personalhealthzone.com Dong Quai (angelica) Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,774,00.html Estropipate Source: Healthnotes, Inc.; www.healthnotes.com Flavonoids Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,782,00.html Gamma Oryzanol Source: Prima Communications, Inc.www.personalhealthzone.com

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Gamma-oryzanol Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10028,00.html Ipriflavone Source: Prima Communications, Inc.www.personalhealthzone.com Isoflavones Source: Prima Communications, Inc.www.personalhealthzone.com Menopause Herbal Combination Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10096,00.html Natural Progesterone Cream Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10099,00.html Progesterone Source: Healthnotes, Inc.; www.healthnotes.com Red Clover Alternative names: Trifolium pratense Source: Healthnotes, Inc.; www.healthnotes.com Red Clover Alternative names: Trifolium pratense , beebread, cow clover, cow grass, meadow clover, purple clover Source: Integrative Medicine Communications; www.drkoop.com Sage Alternative names: Salvia officinalis Source: Healthnotes, Inc.; www.healthnotes.com Soy Isoflavones Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10057,00.html Tang Kuei Source: Integrative Medicine Communications; www.drkoop.com Women's Herbal Combination Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10100,00.html

56 Hot Flashes

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.

57

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

Dissertations on Hot Flashes 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 hot flashes. 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: •

The Relationship between Stress, Cognitive Rumination and Hot Flash Activity by Yellen, Maureen Ochman, Phd from California School of Professional Psychology - San Diego, 1996, 105 pages http://wwwlib.umi.com/dissertations/fullcit/9702199

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.

59

CHAPTER 5. CLINICAL TRIALS AND HOT FLASHES Overview In this chapter, we will show you how to keep informed of the latest clinical trials concerning hot flashes.

Recent Trials on Hot Flashes The following is a list of recent trials dedicated to hot flashes.5 Further information on a trial is available at the Web site indicated. •

Anidulafungin in Treating Immunocompromised Children With Fever and Neutropenia Condition(s): Infection; Neutropenia; unspecified childhood solid tumor, protocol specific; fever, sweats, and hot flashes Study Status: This study is currently recruiting patients. Sponsor(s): National Cancer Institute (NCI) Purpose - Excerpt: RATIONALE: Anidulafungin may be effective in preventing fungal infections in immunocompromised children who have fever and neutropenia. PURPOSE: Phase I/II trial to study the effectiveness of anidulafungin in preventing fungal infections in immunocompromised children who have fever and neutropenia caused by chemotherapy or aplastic anemia. Phase(s): Phase I; Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00068471

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Black cohosh and red clover efficacy for the relief of menopausal symptoms Condition(s): Hot Flashes; Menopause Study Status: This study is currently recruiting patients.

5

These are listed at www.ClinicalTrials.gov.

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Sponsor(s): National Center for Complementary and Alternative Medicine (NCCAM); National Institute of General Medical Sciences (NIGMS); Office of Dietary Supplements (ODS); Office of Research on Women's Health (ORWH) Purpose - Excerpt: This Phase II study, a follow-up to a Phase I trial in normal volunteers, will determine the efficacy of black cohosh and red clover for the relief of menopausal symptoms. It will also assess the safety of chronic dosing (1 year) by evaluating uterine (endometrial biopsies), breast (mammography), and hematology parameters (CBC and chemistry lab values) at baseline and 1 year. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00066144 •

Black Cohosh Extract in Postmenopausal Breast Health Condition(s): Menopause; Hot Flashes Study Status: This study is currently recruiting patients. Sponsor(s): National Center for Complementary and Alternative Medicine (NCCAM) Purpose - Excerpt: The purpose of the study is to determine if black cohosh extract (BCE) administration in symptomatic postmenopausal women results in estrogenic stimulation of the breast, as determined by estradiol, pS2, FSH, LH, and PSA levels in nipple aspirate fluid. Phase(s): Phase I; Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00064831

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Cyproterone Acetate in Treating Hot Flashes Following Surgical or Chemical Castration for Prostate Cancer Condition(s): stage IV prostate cancer; recurrent prostate cancer; Quality of Life; Hot Flashes Study Status: This study is currently recruiting patients. Sponsor(s): Barr Laboratories Purpose - Excerpt: RATIONALE: Cyproterone acetate may be effective treatment for hot flashes following surgical or chemical castration for prostate cancer. It is not yet known which regimen of cyproterone acetate is more effective for hot flashes. PURPOSE: Randomized phase III trial to determine the effectiveness of cyproterone acetate in treating patients who have hot flashes following surgical or chemical castration for prostate cancer. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00005623

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Effects of Black Cohosh on Menopausal Hot Flashes Condition(s): Postmenopause; Hot Flashes; Osteoporosis, Postmenopausal Study Status: This study is currently recruiting patients. Sponsor(s): National Center for Complementary and Alternative Medicine (NCCAM) Purpose - Excerpt: This study will assess whether treatment with black cohosh is effective in reducing the frequency and intensity of menopausal hot flashes. In addition, it will determine whether or not black cohosh reduces the frequency of other menopausal symptoms and improves quality of life. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00010712

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Gabapentin in Treating Hot Flashes in Patients With Prostate Cancer Condition(s): stage I prostate cancer; stage II prostate cancer; stage III prostate cancer; stage IV prostate cancer; recurrent prostate cancer; Hot Flashes Study Status: This study is currently recruiting patients. Sponsor(s): North Central Cancer Treatment Group; National Cancer Institute (NCI) Purpose - Excerpt: RATIONALE: Gabapentin may be effective in relieving hot flashes in men who have prostate cancer. It is not yet known which regimen of gabapentin is most effective in treating hot flashes. PURPOSE: Randomized phase III trial to compare different regimens of gabapentin in treating men who have prostate cancer. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00028574

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Medroxyprogesterone Compared With Venlafaxine in Treating Hot Flashes in Women Condition(s): Hot Flashes Study Status: This study is currently recruiting patients. Sponsor(s): North Central Cancer Treatment Group; National Cancer Institute (NCI) Purpose - Excerpt: RATIONALE: Medroxyprogesterone and venlafaxine may be effective in relieving hot flashes. It is not yet known whether venlafaxine is more effective than medroxyprogesterone in relieving hot flashes. PURPOSE: Randomized phase III trial to compare the effectiveness of medroxyprogesterone with that of venlafaxine in treating women who are experiencing hot flashes. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00030914

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Moxifloxacin Compared With Ciprofloxacin/Amoxicillin in Treating Fever and Neutropenia in Patients With Cancer Condition(s): adult solid tumor; fever, sweats, and hot flashes; hematopoietic and lymphoid cancer; Infection; Neutropenia Study Status: This study is currently recruiting patients. Sponsor(s): EORTC International Antimicrobial Therapy Group Purpose - Excerpt: RATIONALE: Antibiotics such as amoxicillin, ciprofloxacin, and moxifloxacin may be effective in preventing or controlling fever and neutropenia in patients with cancer. It is not yet known whether moxifloxacin alone is more effective than amoxicillin combined with ciprofloxacin in treating neutropenia and fever. PURPOSE: Randomized clinical trial to compare the effectiveness of moxifloxacin with that of ciprofloxacin combined with amoxicillin in treating neutropenia and fever in patients who have cancer. Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00062231

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Soy Protein Supplement In Treating Hot Flashes in Postmenopausal Women Receiving Tamoxifen for Breast Cancer Condition(s): stage I breast cancer; stage II breast cancer; stage IIIA breast cancer; recurrent breast cancer; intraductal breast carcinoma; Hot Flashes Study Status: This study is currently recruiting patients. Sponsor(s): Cancer and Leukemia Group B; National Cancer Institute (NCI) Purpose - Excerpt: RATIONALE: Soy protein supplement may be effective in reducing hot flashes in postmenopausal women who are receiving tamoxifen for breast cancer. PURPOSE: Randomized phase II trial to determine the effectiveness of soy protein supplement in reducing hot flashes in postmenopausal women who are receiving tamoxifen for breast cancer. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00031720

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Alternative Therapies for Menopause: A Randomized Trial Condition(s): Menopause; Hot Flashes Study Status: This study is no longer recruiting patients. Sponsor(s): National Institute on Aging (NIA) Purpose - Excerpt: This randomized, controlled trial will evaluate the efficacy and safety of three alternative approaches utilizing phytoestrogens to treat hot flashes and night sweats in peri- and post-menopausal women. The treatments were chosen because of the scientific evidence supporting a possible benefit, the availability of products with adequate quality control, and their frequency of use in naturopathic medicine. RECRUITMENT FOR THIS STUDY SHOULD END BY AUGUST 1, 2003. Study Type: Interventional

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Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00061711 •

Antibiotic Therapy With or Without G-CSF in Treating Children With Neutropenia and Fever Caused by Chemotherapy Condition(s): unspecified childhood solid tumor, protocol specific; fever, sweats, and hot flashes; Neutropenia Study Status: This study is no longer recruiting patients. Sponsor(s): Children's Oncology Group; National Cancer Institute (NCI) Purpose - Excerpt: RATIONALE: Antibiotics may decrease the side effects of neutropenia and fever caused by chemotherapy. Colony-stimulating factors such as GCSF may increase the number of immune cells found in bone marrow or peripheral blood and may help a person's immune system recover from the side effects of chemotherapy. It is not yet known whether antibiotic therapy plus G-CSF is more effective than antibiotic therapy alone for treating side effects caused by chemotherapy. PURPOSE: Randomized phase III trial to compare the effectiveness of antibiotic therapy with or without G-CSF in treating children who have neutropenia and fever that are caused by chemotherapy. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00003739

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Gabapentin For the Control of Hot Flashes in Women With Breast Cancer Condition(s): Anxiety Disorder; Breast Cancer; Depression; Hot Flashes; Quality of Life Study Status: This study is no longer recruiting patients. Sponsor(s): James P. Wilmot Cancer Center; National Cancer Institute (NCI) Purpose - Excerpt: RATIONALE: Gabapentin may be effective for the control of hot flashes. It is not yet known if gabapentin is effective in treating hot flashes. PURPOSE: Randomized clinical trial to study the effectiveness of gabapentin in controlling hot flashes in women who have breast cancer. Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00022074

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Hormone Replacement Therapy for Hot Flashes and/or Vaginal Symptoms in Postmenopausal Women Receiving Tamoxifen for Breast Cancer Condition(s): stage I breast cancer; ductal breast carcinoma; menopausal symptoms; Hot Flashes; stage II breast cancer; breast cancer in situ Study Status: This study is no longer recruiting patients. Sponsor(s): National Cancer Institute (NCI); Eastern Cooperative Oncology Group Purpose - Excerpt: RATIONALE: Hormone replacement therapy may be effective in managing the hot flashes and/or vaginal symptoms in postmenopausal women who are receiving tamoxifen for breast cancer. PURPOSE: Randomized phase III trial to

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determine the effectiveness of hormone replacement therapy in managing hot flashes and/or vaginal symptoms in postmenopausal women who are receiving tamoxifen for breast cancer. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00026286 •

A Study of the Pharmocokinetics of Black Cohosh Condition(s): Hot Flashes Study Status: This study is not yet open for patient recruitment. Sponsor(s): National Center for Complementary and Alternative Medicine (NCCAM) Purpose - Excerpt: Black cohosh is a natural supplement that has been used to treat and prevent menopausal symptoms. Remifemin is a standardized form of black cohosh. The purpose of this study is to determine the levels of components of black cohosh obtained in the blood of healthy women taking Remifemin. Phase(s): Phase I Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00068185

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Black Cohosh in Treating Hot Flashes in Women Who Have or Who Are At Risk of Developing Breast Cancer Condition(s): stage IV breast cancer; stage I breast cancer; stage II breast cancer; stage IIIA breast cancer; stage IIIB breast cancer; Hot Flashes Study Status: This study is not yet open for patient recruitment. Sponsor(s): North Central Cancer Treatment Group; National Cancer Institute (NCI) Purpose - Excerpt: RATIONALE: The herbal supplement black cohosh may be effective in relieving hot flashes in women. PURPOSE: Randomized phase III trial to determine the effectiveness of black cohosh in relieving hot flashes in women who have breast cancer or who are at risk of developing breast cancer. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00060320

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Goserelin in Preventing Early Menopause in Women Receiving Adjuvant Chemotherapy for Breast Cancer Condition(s): Breast Cancer; Hot Flashes; menopausal symptoms; Osteoporosis; sexual dysfunction and infertility Study Status: This study is not yet open for patient recruitment. Sponsor(s): Southwest Oncology Group; National Cancer Institute (NCI)

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Purpose - Excerpt: RATIONALE: Goserelin blocks hormone production in the ovaries. It is not yet known whether ovarian suppression using goserelin will prevent early menopause in women receiving chemotherapy for breast cancer. PURPOSE: Randomized phase III trial to study the effectiveness of ovarian suppression using goserelin in preventing early menopause in women who are receiving adjuvant chemotherapy for stage I, stage II, or stage IIIA breast cancer. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00068601

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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CHAPTER 6. PATENTS ON HOT FLASHES 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.6 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 “hot flashes” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on hot flashes, we have not necessarily excluded non-medical patents in this bibliography.

Patents on Hot Flashes By performing a patent search focusing on hot flashes, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an 6Adapted

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

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

Compounds and methods for modulation of estrogen receptors Inventor(s): Rice; Kenneth D. (Mill Valley, CA), McKie; Jeffrey A. (San Diego, CA), Gangloff; Anthony R. (Daly City, CA), Chao; Qi (San Diego, CA), Gayo-Fung; Leah Marie (San Diego, CA), Bhagwat; Shripad S. (San Diego, CA), Stein; Bernd M. (San Diego, CA) Assignee(s): Signal Pharmaceuticals, Inc. (San Diego, CA) Patent Number: 6,593,322 Date filed: September 21, 2000 Abstract: Compounds that modulate the estrogen receptor (ER) are disclosed, as well as pharmaceutical compositions containing the same. In a specific embodiment, the compounds are selective for ER-.beta. over ER-.alpha. Methods are disclosed for modulating ER-.beta. in cell and/or tissues expressing the same, including cells and/or tissue that preferentially ER-.beta. Methods for treating estrogen-related conditions are also disclosed, including conditions such as is breast cancer, testicular cancer, osteoporosis, endometriosis, cardiovascular disease, hypercholesterolemia, prostatic hypertrophy, prostatic carcinomas, obesity, hot flashes, skin effects, mood swings, memory loss, urinary incontinence, hairloss, cataracts, natureal hormonal imbalances, and adverse reproductive effects associated with exposure to environmental chemicals. Excerpt(s): This invention is generally directed to estrogen antagonists and agonists, including pharmaceutical compositions and uses thereof, and more specifically to compounds which selectively modulate estrogen receptor-beta (ER-.beta.) activity. The estrogen hormone has a broad spectrum of effects on tissues in both females and males. Many of these biological effects are positive, including maintenance of bone density, cardiovascular protection, central nervous system (CNS) function, and the protection of organ systems from the effects of aging. However, in addition to its positive effects, estrogen also is a potent growth factor in breast and endometrium that increases the risk of cancer. Until recently, it has been assumed that estrogen binds to a single estrogen receptor (ER) in cells, causing conformational changes that result in release from heat shock proteins and binding of the receptor as a dimer to the so-called estrogen response element in the promoter region of a variety of genes. Further, pharmacologists have generally believed that non-steroidal small molecule ligands compete for binding of estrogen to ER, acting as either antagonists or agonists in each tissue where the estrogen receptor is expressed. Thus, such ligands have traditionally been classified as either pure antagonists or agonists. This is no longer believed to be correct. Web site: http://www.delphion.com/details?pn=US06593322__

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Method for treating hot flashes in humans Inventor(s): Bobrove; Arthur M. (1539 Walnut Dr., Palo Alto, CA 94030), Urman; Jeffrey D. (1880 Hamilton Ave., Palo Alto, CA 94303) Assignee(s): none reported Patent Number: 6,395,757 Date filed: July 23, 1999

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Abstract: This invention is directed to methods for treating hot flashes as a consequence of declining levels of estrogen or androgen in humans. Specifically, the methods of this invention involve the topical administration of a glycopyrrolate analog of Formula (I) to humans. Excerpt(s): This invention is directed to methods for treating hot flashes as a consequence of declining estrogen levels or androgen levels in humans. Specifically, the methods of this invention involve the topical administration of a therapeutically effective amount of a glycopyrrolate analog to a human suffering from hot flashes. 9. U.S. Pat. No. 5,525,347, Kellner et al. 10. U.S. Pat. No. 2,956,062, Lunsford et al. Web site: http://www.delphion.com/details?pn=US06395757__ •

Method of preparing and using isoflavones for the treatment of female symptoms Inventor(s): Empie; Mark (Forsyth, IL), Gugger; Eric (Latham, IL) Assignee(s): Archer Daniesl Midland Company (Decatur, IL) Patent Number: 6,391,309 Date filed: July 13, 2000 Abstract: A composition is prepared by extracting phytochemicals from plant matter to form a dietary supplement for treatment of female symptoms. This composition is enriched preferably with two or more fractions of plant matter, namely: isoflavones, lignans, saponins, sapogenins, catechins and phenolic acids. Soy is the preferred source of these chemicals; however, other plants may also be used, such as wheat, psyllium, rice, oats, red clover, kudzu, alfalfa, flax, and cocoa. The isoflavone may be any in a group including malonyl, acetyl, glucoside, and aglycone. The composition is in a concentrated form to be delivered in an easy to consume dosage, such as a pill, tablet, liquid, capsule, or a food supplement including health bars. Most commonly, these female symptoms are hot flashes, osteoporosis, sleep disorders, menopausal symptoms, vaginal dryness, premenstrual syndrome, or other problems relating to a reduction of sex hormones and to menstruation. Excerpt(s): This invention relates to compositions extracted from vegetable matter and more particularly to phytochemicals including saponogenins and saponins, catechins, lignans, phenolic acids, and isoflavones, and especially those extracted from a family of plants including soy, flax, tea and cocoa and methods of sing these compositions as nutritional supplements or food additives. As used herein, the term "isoflavone" includes malonyl, acetyl, glucoside, and aglycone forms of the isoflavones. Currently, western women suffer symptoms, especially in mid-life, which Asian women do not suffer. It is thought that diet accounts for these differences. It is further thought that may of these symptoms are either preventable or treatable by a use of phytochemicals, especially isoflavones, as a source of supplemental hormones, and particularly if such use begins before a woman's puberty. Men also benefit from such phytochemical treatments which address prostate cancer; however, the benefits do not appear to be so dependent upon when the use of isoflavones begins. Web site: http://www.delphion.com/details?pn=US06391309__

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Method of treating symptoms of hormonal variation, including hot flashes Inventor(s): Guttuso, Jr.; Thomas J. (Rochester, NY) Assignee(s): University of Rochester (Rochester, NY) Patent Number: 6,310,098 Date filed: July 21, 2000 Abstract: One aspect of the present invention relates to a method of treating hot flashes in a patient which is carried out by providing a compound which binds a.alpha.sub.2.delta. subunit of a voltage-gated calcium channel and administering the compound to a patient experiencing hot flashes under conditions effective to treat the hot flashes. Another aspect of the present invention relates to a method for treating a symptom of hormonal variation in a patient which is carried out by providing a compound which binds a.alpha.sub.2.delta. subunit of a voltage-gated calcium channel and administering the compound to a patient experiencing a symptom of hormonal variation under conditions effective to treat the symptom of hormonal variation. Further aspects of the present invention relate to the administration of a compound which binds a.alpha.sub.2.delta. subunit of a voltage-gated calcium channel as an anti-pyretic agent (for treating fever) or as an anti-emetic agent (for treating nausea and emesis). Excerpt(s): The present invention relates generally to methods of treating symptoms of hormonal variation, including hot flashes, treating fever, and treating nausea and emesis. Hot flashes or flushing occur commonly in menopausal women. This is characterized by a sudden onset of warmth in the face and neck and often progressing to the chest. Such an episode generally lasts several minutes and is evidenced by a visible flushing of the skin. Often such episodes are accompanied by sweating, dizziness, nausea, palpitations and diaphoresis. Such symptoms can disrupt sleep and interfere with the quality of life. Although the cause of hot flashes are not completely understood, they are thought to be a disorder of thermoregulation resulting from a transient lowering of the hypothalamic temperature regulatory set point (Kronenberg et al., "Thermoregulatory Physiology of Menopausal Hot Flashes: A Review," Can. J. Physiol. Pharmacol., 65:1312-1324 (1987)). In post-menopausal woman, the cause of such hot flashes is believed to be a consequence of declining estrogen levels. Thus, it is not surprising that hot flashes also occur in a high percentage of women taking the antiestrogen drug tamoxifen. Men may also have hot flashes following androgendeprivation therapy (from bilateral orchiectomy or treatment with a gonadotrophinreleasing-hormone agonist) for metastatic prostate cancer. Web site: http://www.delphion.com/details?pn=US06310098__

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Methods for treating hot flashes and improving the quality of life of castrated prostatic cancer patients Inventor(s): Bell; Robert G. (Palm Harbor, FL) Assignee(s): Barr Laboratories, Inc. (Pomona, NY) Patent Number: 6,165,504 Date filed: September 23, 1998 Abstract: A method for treating hot flashes in a castrated prostatic cancer patient who is diagnosed with hot flashes warranting treatment or who is experiencing at least approximately 5 hot flashes per day is provided in which from 25 mg to 150 mg

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cyproterone acetate per day is orally administered to the patient. A method for improving the multidimensional quality of life of such a patient is also provided. Palliative therapy for an advanced stage patient also improves quality of life. Excerpt(s): The present invention relates to a treatment for surgically or chemically castrated prostatic cancer patients which alleviates hot flashes. The present invention also relates to a treatment for castrated prostatic cancer patients which improves the patients' quality of life. Surgical and chemical (LH-RH agonists) castration are widely used for the treatment of patients with prostate cancer. Apart from impotence, the most frequent long-term side effect of such therapy is the onset of distressing hot flashes (also known as hot flushes) similar to those seen in postmenopausal women. Vasomotor hot flashes and sweats occur in up to 80% of prostate cancer patients following either orchiectomy or treatment with LH-RH agonists. As many as one-third of these patients will experience persistent and frequent symptoms severe enough to cause significant discomfort and inconvenience. In one study in prostate cancer patients undergoing surgical castration, Charig and Rundle, (Urology (1989) 18: 175-178), found that 76% of their patients experienced hot flashes, and 30% believed their symptoms warranted treatment. In this study hot flashes started on average two to three months postoperatively and lasted in some patients for more than three years. However, the pattern in any individual patient was unpredictable. These results are in agreement with those of another study conducted in Sweden, as an attempt to quantify the degree of flashing by measuring skin blood flow and water evaporation. Froedin, T., The Prostate (1985) 7:203-208. The results of several other clinical trials reveal an incidence of hot flashes and sweats in about 40-80% of surgically or chemically castrated prostate cancer patients. One-third of all patients seek palliation and in many patients the symptoms may start as early as one to two weeks after castration. Hot flashes can be extremely bothersome. They sometimes occur several times an hour, and they often occur at night. Hot flashes and outbreaks of sweats occurring during the night can cause sleep deprivation. Symptoms observed such as nervousness, fatigue, depression or inability to concentrate are considered to be caused by the sleep deprivation following night sweats. (Kramer, P., et al., In: Murphy G., et al., 3rd Int'l Symposium on Recent Advances in Urological Cancer Diagnosis and Treatment--Proceedings. Paris, France: SCI: 3-7 (1992)). Hot flashes can start without any warning. The attacks can last up to thirty minutes and vary in their frequency from several times a week to more than a dozen attacks per day. Hot flashes are associated with increased pulse rate. Generally, they are a source of great physical and mental stress to the prostate cancer patient. The vasomotor hot flashes often warrant medical treatment, yet a satisfactory treatment having few side effects has not been forthcoming. Web site: http://www.delphion.com/details?pn=US06165504__ •

Methods of treating hot flashes, estrogen deficiencies and deferring menopause by the administration of a luteinizing hormone antagonist Inventor(s): Groendahl; Christian (Vaerloese, DK) Assignee(s): Novo Nordisk A/S (Bagsvaerd, DK) Patent Number: 6,297,243 Date filed: October 29, 1998 Abstract: A pharmaceutical composition comprising a LH antagonist or a pharmaceutically acceptable salt thereof, and a pharmaceutically acceptable carrier is useful for deferring the onset of menopause.

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Excerpt(s): The present invention relates to a pharmaceutical composition, to use of luteinizing hormone (LH) antagonists for preparing a medicament for treatment of hot flushes or hot flashes (i.e., menopausal vaso-motor symptoms), to use of LH antagonists for preparing a medicament for treatment of estrogen deficiencies, to use of LH antagonists for preparing a medicament for decreasing the loss of follicles during the pre- and per-menopausal period, thereby deferring the onset of menopause and consequently the symptoms related to lack of estrogen. Furthermore the invention relates to use of LH antagonists for preparing a contraceptive. The mammalian female is born with a fixed and subsequently decreasing number of meiotically arrested oocytes in the ovaries. Oocytes encompassed by a single layer of flattened epithelial cells form primordial follicles and constitute the fixed resting pool of oocytes in the ovaries from which oocytes are recruited throughout the reproductive life. An unknown signal triggers a cohort of the primordial follicles to develop into primary, secondary and ultimately Graafian follicles. Approximately one million primordial follicles is present in a human ovary in a newborn. The functional activity of the human ovary depends on the size of the follicle store. It has been speculated that a threshold exist of approximately 1000-2000 oocytes that mediates the onset of menopause or cessation of cyclic activity in the ovary (Gosden, 1996, Serono Symposium, Leeds). Web site: http://www.delphion.com/details?pn=US06297243__ •

Nociceptin analogues Inventor(s): Scheideler; Mark (DK-2200 K.o slashed.benhavn N, DK), Madsen; Kjeld (DK-3500 V.ae butted.rl.o slashed.se, DK), Olsen; Uffe Bang (DK-2625 Vallensb.ae butted.k, DK), Johansen; Nils Langeland (DK-2100 Copenhagen.O slashed., DK), Th.o slashed.gersen; Henning (DK-3520 Farum, DK) Assignee(s): Novo Nordisk A/S (Bagsvaerd, DK) Patent Number: 5,998,375 Date filed: July 14, 1998 Abstract: The present invention relates to novel peptides, pharmaceutical compositions containing them, methods for preparing the compounds, use of the compounds for preparing medicaments for treating vasomotor disturbances, in particular the peripheral vasomotor effects known as hot flushes or hot flashes, and to a method of treating vasomotor disturbances. Excerpt(s): The present invention relates to novel peptides, pharmaceutical compositions containing them, methods for preparing the compounds, use of the compounds for preparing medicaments for treating vasomotor disturbances, in particular the peripheral vasomotor effects known as hot flushes or hot flashes, and to a method of treating vasomotor disturbances. A "hot flush" is a sudden transient sensation ranging from warmth to intense heat and typically accompanied by flushing and perspiration. It is the classic sign of the menopause and the predominant complaint of menopausal women. Epidemiological studies report that the majority of menopausal women experience hot flushes, although with large variation in frequency and intensity (Treatment of the Postmenopausal Woman, Basic and Clinical Aspects, Raven Press 1994, ed. R. A. Lobo). A positive correlation between plasma levels of calcitonin gene-related peptide (CGRP) and frequency of hot flushes in women has recently been reported (Chen et al., 1993, Lancet (342) 49), in accordance with the potent vasodilatory effect of CGRP (Brain et al., 1985, Nature, (313) 54-56).

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Web site: http://www.delphion.com/details?pn=US05998375__ •

Treatment of hot flashes (flushing) using leucine alone or in combination with other branched chain amino acids Inventor(s): Gollobin; Charlotte (6710 Bradley Blvd., Bethesda, MD 20817) Assignee(s): none reported Patent Number: 6,245,812 Date filed: July 15, 1999 Abstract: A method for treating flushing caused by other means than normal estrogen decreases associated with normal or natural menopause. Specifically, the method comprises administering to a patient in need thereof an effective amount of leucine, or leucine in combination with isoleucine, valine and mixtures of isoleucine and valine. Treatment may be achieved via manipulation of dietary protein intake or through direct administration, e.g., dietary supplement or the like. An article of manufacture is also provided. Excerpt(s): This invention is directed to a method for treating hot flashes (flushing) and the like. Specifically, this invention is directed to treatment of flushing and the like caused by means other than the normal reduction of estrogen associated with menopause comprising administering to a patient, an effective amount of leucine. Leucine may be administered by manipulation of diet or in a composition comprising an effective amount of leucine and a pharmaceutically acceptable carrier. A combination of leucine with other branched chain amino acids such as, isoleucine and valine is preferred. Menopausal syndrome consists of a number of varying and often highly distressing symptoms resulting from hormonal imbalance in the female body, specifically a deficiency of estrogen in the body. Symptoms of menopausal syndrome sufficiently severe to require treatment occur in approximately 50 percent of women. One particular symptom experienced by women is hot flashes or flushing. This is characterized by a sudden onset of warmth in the face and neck and often progressing to the chest. Such an episode generally lasts several minutes and is evidenced by a visible red flushing of the skin. Often such episodes are accompanied by sweating, dizziness, nausea, palpitations and diaphoresis. In U.S. Pat. No. 5,789,443, granted on Aug. 4, 1998, the contents of which are expressly incorporated by reference as if fully set forth herein, the use of leucine either alone or in combination with other branched chain amino acids has been described for the treatment of flushing and the like associated with menopause. Web site: http://www.delphion.com/details?pn=US06245812__

•

Use of male essence to alter female endocrine response Inventor(s): Cutler; Winnifred B. (Haverford, PA), Preti; George (Horsham, PA), Garcia; Celso R. (Merion, PA) Assignee(s): Trustees of the University of Penn. (Philadelphia, PA) Patent Number: 5,155,045 Date filed: April 30, 1986

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Abstract: A novel method for treating a human female is disclosed comprising the step of exposing the nasal region of said female to at least a portion of the axillary secretions of a human male. This exposure is preferably continued in amounts and for a duration which are effective to significantly alter an endocrine related characteristic, such as the menstrual cycle length, of that female. In particular, the portions of male axillary secretions to be exposed to the female preferably comprise one or more compounds such as androstenol, dehydroepiandrosterone, and/or a compound or compounds exhibiting a burnt heavy axiallary-like odor which elutes at about 50 minutes as shown on the FID response curve of FIG. 3B. Studies show that pooled male donor secretions are effective to alter aberrant menstrual cycles, particularly those exhibiting luteal phase defects such that they become presumptively fertile menstrual cycles having durations of about 29.5.+-.3 days. Symptoms of perimenopause, such as hot flashes, night sweats and irregular menstrual cycles, are also treatable using the methods of this invention, which tend to promote female endocrine regularity and longevity. Excerpt(s): The present application is related to U.S. Pat. Nos. 3,986,494 entitled "Method of Predicting and Detecting Ovulation" (Preti and Huggins); 4,010,738, entitled "Method of Predicting and Detecting Ovulation" (Preti and Huggins); 4,119,089, entitled "Method of Predicting and Determining Ovulation by Monitoring the Concentration of Volatile Sulfur-Containing Compounds Present in Mouth Air" (Preti, Huggins and Tonzetich); and 4,385,125, entitled "Method Detecting Ovulation by Monitoring Dodecanol Concentration in Saliva" (Preti, Kostelc, Tonzetich and Huggins), each of which patents is hereby incorporated by reference as if fully set forth herein. This application is also related to U.S. application 695,053, filed Jan. 25, 1985, entitled "Axillary Androstenol and Dehydroepiandrosterone as Fertile Period Onset Indicators" Attorney Docket MON-40), now abandoned, which application is hereby incorporated by reference as if fully set forth herein. This application is also related to U.S. application 694,946, filed Jan. 25, 1985, entitled "Method Using Pooled Female Axillary Essence From Multiple Donors to Alter Menstrual Cycle Timing", (Attorney Docket MON-38), now abandoned, which application is hereby incorporated by reference as if fully set forth herein. Web site: http://www.delphion.com/details?pn=US05155045__ •

Using complex herbal formulations to treat hot flashes Inventor(s): Yng-Wong; Quing Non (5524 MacArthur Blvd., Washington, DC 20016) Assignee(s): none reported Patent Number: 5,874,084 Date filed: July 19, 1996 Abstract: Hot flashes (intense heat sensation, flushing, profuse sweating, palpitations, and/or sense of anxiety) in a menopausal woman may be substantially eliminated or ameliorated by administering to a woman in need of treatment an effective amount of ingestible material which has as substantially the only active ingredient a herbal complex. These exemplary herbal complex formula utilize a number of different species of herbs using the unique properties found in different parts of the plant, the root, the leaves, the aerial parts, the bark and the rhizomes. Excerpt(s): It is well recognized that women in many countries (the percentage often varying from country to country, however, due to dietary and lifestyle differences) experience what are commonly termed "hot flashes" at menopause. In fact more women seek medical treatment for hot flashes then for any other menopausal complaint. Hot

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flashes are defined in the literature as brief (often disabling) periods of intense heat sensation, flushing, profuse sweating, palpitations and/or sense of anxiety. Current therapy in the United States and some other countries for the treatment of hot flashes is estrogen replacement. However various estrogen treatment formulas have undesirable side effects (for example as described in U.S. Pat. No. 4,096,254), and usually estrogen replacement is not a practical or viable option for women who have had cancer or who are at high cancer risk levels for cancers that are affected by hormone levels. Also estrogen replacement is considered undesirable by some individuals, and a less extreme treatment medicine is desired by many. According to the present invention, various herbal complexes are provided which can be administered to practice a method of substantially eliminating or ameliorating hot flashes. According to one aspect of the present invention this method comprises the step of administrating to a menopausal woman in need of treatment ingestible material that consists essentially of a complex herbal formulation in an amount effective to substantially eliminate or ameliorate brief periods of intense heat sensation, flushing, profuse sweating, palpitations, and for sense of anxiety (hot flashes). The complex herbal formulation is essentially free of human or animal origin estrogen or other female hormones. Substantially inert ingredients may also be added to the complexes to affect their taste, bulk, texture, or other attributes. While a number of herbal complexes may achieve pharmacologically effective results according to the invention, three particular pharmacologically effective compositions have been identified. The first pharmacologically effective composition comprises a mixture of Curculigo orchioides, Epimedium grandiflorum, Angelica sinensis, Morinda officinalis, Anemarrhena asphodeloides, Phellodendron amurense, Leonurus heterophyllus and Millettia dielsiana, in a pharmacologically effective amount. The second formulation comprises a pharmacologically effective composition comprising a mixture of Glycyrrhizae uralensis, Glycyrrhizae glabra, Astragalus membraneaceus, Poria cocos, Atractylodes lancea, Saussurea lappa, Polygala tenuifolia, Gardenia jasminoides, Cinnamomum cassia, Ziziphus jujuba, Panax ginseng, and Angelica sinensis, in a pharmacologically effective amount. A third pharmacologically effective composition comprises a mixture of Paeonia suffruticosa, Lycium chinense, Paeonia lactiflora, Paeonia lactiflora, Rehmannia glutinosa, Artemisia apiacea, Poria cocos, Phellodendron amurense, Bupleurum scorzoneraefolium, Coptis chinensis, and Cinnamomum cassia, in a pharmacologically effective amount. Web site: http://www.delphion.com/details?pn=US05874084__ •

Wrist cooler for relief of hot flashes and similar symptoms Inventor(s): Lerner; Irene K. (3533 R.F.D., Long Grove, IL 60047) Assignee(s): none reported Patent Number: 5,956,963 Date filed: January 16, 1997 Abstract: The invention offers relief for hot flash symptoms of menopause and body overheating by providing a wrist cooler. The cooler preferably includes chemical cooling pellets that remain in a solid state until broken. A woman experiencing symptoms such as menopausal hot flashes carries the cooler in her purse. When hot flashes occur, the cooler is removed from her purse, the pellets are broken and the cooler is slid onto her wrist. Once the flashes have subsided, the cooler is discarded. The invention is easily transportable and provides for immediate relief, as there are no reusable cooling elements to be frozen or chilled.

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Excerpt(s): The invention offers relief for hot flash symptoms of menopause and body overheating by providing a wrist cooler. The cooler preferably includes chemical cooling pellets that remain in a solid state until broken. A woman experiencing symptoms such as menopausal hot flashes carries the cooler in her purse. When hot flashes occur, the cooler is removed from her purse, the pellets are broken and the cooler is slid onto her wrist. Once the flashes have subsided, the cooler is discarded. The invention is easily transportable and provides for immediate relief, as there are no reusable cooling elements to be frozen or chilled. Hot flashes and similar symptoms can be experienced by women of all ages. Since women are living longer lives, symptoms such as hot flashes not only are more commonly encountered but also are being openly discussed and relief more actively pursued. The invention provides a non-pharmaceutical, quick and efficient way to relieve symptoms that women of all ages might experience. Web site: http://www.delphion.com/details?pn=US05956963__

Patent Applications on Hot Flashes As of December 2000, U.S. patent applications are open to public viewing.7 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 hot flashes: •

Compounds and methods for modulation of estrogen receptors Inventor(s): Chao, Qi; (San Diego, CA), Gayo-Fung, Leah M.; (San Diego, CA), Bhagwat, Shripad S.; (San Diego, CA) Correspondence: PENNIE AND EDMONDS; 1155 AVENUE OF THE AMERICAS; NEW YORK; NY; 100362711 Patent Application Number: 20030087901 Date filed: February 27, 2002 Abstract: Compounds that modulate the estrogen receptor (ER) are disclosed, as well as pharmaceutical compositions containing the same. In a specific embodiment, the compounds are selective modulators for ER-.beta. over ER-.alpha. Methods are disclosed for modulating ER-.beta. in cell and/or tissues expressing the same, including cells and/or tissue that preferentially express ER-.beta. More generally, methods for treating estrogen-related conditions are also disclosed, including conditions such as is breast cancer, testicular cancer, osteoporosis, endometriosis, cardiovascular disease, hypercholesterolemia, prostatic hypertrophy, prostatic carcinomas, obesity, hot flashes, skin effects, mood swings, memory loss, urinary incontinence, hairloss, cataracts, natural hormonal imbalances, and adverse reproductive effects associated with exposure to environmental chemicals. Excerpt(s): This application claims the benefit of U.S. Provisional Application No. ______ filed Mar. 17, 1999; which provisional application was originally filed as U.S. application Ser. No. 09/270,977 on Mar. 17, 1999. This invention is generally directed to estrogen antagonists and agonists, including pharmaceutical compositions and uses thereof, and more specifically to compounds which selectively modulate estrogen receptor-beta (ER-.beta.) activity. The estrogen hormone has a broad spectrum of effects

7

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

Patents 77

on tissues in both females and males. Many of these biological effects are positive, including maintenance of bone density, cardiovascular protection, central nervous system (CNS) function, and the protection of organ systems from the effects of aging. However, in addition to its positive effects, estrogen also is a potent growth factor in breast and endometrium that increases the risk of cancer. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Estrogen receptor modulators Inventor(s): Wildonger, Kenneth J.; (Bridgewater, NJ), Parker, Dann LeRoy JR.; (Cranford, NJ), Ratcliffe, Ronald W.; (Matawan, NJ), Wilkening, Robert R.; (Maplewood, NJ) Correspondence: MERCK AND CO INC; P O BOX 2000; RAHWAY; NJ; 070650907 Patent Application Number: 20030027840 Date filed: February 14, 2001 Abstract: The present invention relates to compounds and derivatives thereof, their synthesis, and their use as estrogen receptor modulators. The compounds of the instant invention are ligands for estrogen receptors and as such may be useful for treatment or prevention of a variety of conditions related to estrogen functioning including: bone loss, bone fractures, osteoporosis, cartilage degeneration, endometriosis, uterine fibroid disease, hot flashes, increased levels of LDL cholesterol, cardiovascular disease, impairment of cognitive functioning, cerebral degenerative disorders, restinosis, gynacomastia, vascular smooth muscle cell proliferation, obesity, incontinence, and cancer, in particular of the breast, uterus and prostate. Excerpt(s): Naturally occurring and synthetic estrogens have broad therapeutic utility, including: relief of menopausal symptoms, treatment of acne, treatment of dysmenorrhea and dysfunctional uterine bleeding, treatment of osteoporosis, treatment of hirsutism, treatment of prostatic cancer, treatment of hot flashes and prevention of cardiovascular disease. Because estrogen is very therapeutically valuable, there has been great interest in discovering compounds that mimic estrogen-like behavior in estrogen responsive tissues. For example, estrogen-like compounds would be beneficial in the as treatment and prevention of bone loss. Bone loss occurs in a wide range of subjects, including women that are post-menopausal or have had a hysterectomy, patients who were or are currently being treated with corticosteroids, and patient's having gonadal dysgenesis. The current major bone diseases of public concern are osteoporosis, hypercalcemia of malignancy, osteopenia due to bone metastases, periodontal disease, hyperparathyroidism, periarticular erosions in rheumatoid arthritis, Paget's disease, immobilization-induced osteopenia, and glucocorticoid-induced osteoporosis. All of these conditions are characterized by bone loss, resulting from an imbalance between bone resorption, i.e. breakdown, and bone formation, which continues throughout life at the rate of about 14% per year on the average. However, the rate of bone turnover differs from site to site, for example, it is higher in the trabecular bone of the vertebrae and the alveolar bone in the jaws than in the cortices of the long bones. The potential for bone loss is directly related to turnover and can amount to over 5% per year in vertebrae immediately following menopause, a condition which leads to increased fracture risk. In the U.S., there are currently about 20 million people with detectable fractures of the vertebrae due to osteoporosis. In addition, there are about 250,000 hip fractures per year attributed to osteoporosis. This clinical situation is associated with a 12% mortality rate

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within the first two years, while 30% of the patients require nursing home care after the fracture. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Method for the stereoselective synthesis of cyclic amino acids Inventor(s): Blakemore, David Clive; (Cambridge, GB), Bryans, Justin Stephen; (Balsham, GB), Williams, Sophie Caroline; (Cambridge, GB) Correspondence: Elizabeth M Anderson; Warner Lambert Company; 2800 Plymouth Road; Ann Arbor; MI; 48105; US Patent Application Number: 20030069438 Date filed: June 6, 2002 Abstract: 1The instant invention is a route to stereospecific 3-substituted 5-membered ring isomers of Formula (A). The final products are useful as agents in the treatment of epilepsy, faintness attacks, hypokinesia, cranial disorders, neurodegenerative disorders, depression, anxiety, panic, pain, neuropathological disorders, gastrointestinal disorders such as irritable bowel syndrome (IBS), inflammation especially arthritis, sleep disorders, premenstrual syndrome, and hot flashes. The invention provides novel routes to synthesize stereoselectively analogs of gabapentin (Neurontin.TM.) of Formulas (I), (II), (III) and (IV) wherein R is C.sub.1-C.sub.10 alkyl or C.sub.3-C.sub.10 cycloalkyl and pharmaceutically acceptable salts thereof. Excerpt(s): wherein R.sub.1 is hydrogen or a lower alkyl radical and n is 4, 5, or 6 are known in U.S. Pat. No. 4,024,175 and its divisional U.S. Pat. No. 4,087,544. The uses disclosed are: protective effect against cramp induced by thiosemicarbazide; protective action against cardiazole cramp; the cerebral diseases, epilepsy, faintness attacks, hypokinesia, and cranial traumas; and improvement in cerebral functions. The compounds are useful in geriatric patients. The patents are hereby incorporated by reference. or a pharmaceutically acceptable salt thereof wherein R is hydrogen or a lower alkyl; and R.sub.1 to R.sub.8 are each independently selected from hydrogen, straight or branched alkyl of from 1 to 6 carbon atoms, phenyl, benzyl, fluorine, chlorine, bromine, hydroxy,. hydroxymethyl, amino, aminomethyl, trifluoromethyl, -CO.sub.2H, --CO.sub.2R.sub.15, --CH.sub.2CO.sub.2H, --CH.sub.2CO.sub.2R.sub.15, -OR.sub.15 wherein R.sub.15 is a straight or branched alkyl of from 1 to 6 carbons, phenyl, or benzyl, and R.sub.1 to R.sub.8 are not simultaneously hydrogen. This patent application is hereby incorporated by reference. when R.sub.3, R.sub.5, Z.sub.1, Z.sub.2, or Z.sub.3 is X(CH.sub.2).sub.nR.sub.8 and n is not zero, X is oxygen or NR.sub.6 when R.sub.8 is OR.sub.6 or CO.sub.2H. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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•

Method of treating symptoms of hormonal variation, including hot flashes, using tachykinin receptor antagonist Inventor(s): Guttuso, Thomas J. JR.; (Rochester, NY) Correspondence: Michael L. Goldman; NIXON PEABODY LLP; Clinton Square; P.O. Box 31051; Rochester; NY; 14603; US Patent Application Number: 20020016283 Date filed: June 12, 2001 Abstract: The present invention relates to a methods of treating hot flashes and symptoms of hormonal variation in a patient, which methods include providing a tachykinin receptor antagonist and administering the tachykinin receptor antagonist to a patient experiencing a symptom of hormonal variation under conditions effective to treat the symptom of hormonal variation, which symptoms of hormonal variation can include hot flashes. Excerpt(s): This application claims priority benefit of U.S. Provisional Patent Application Ser. No. 60/211,116, filed Jun. 12, 2000, which is hereby incorporated by reference in its entirety. The present invention relates generally to methods of treating symptoms of hormonal variation, including hot flashes. Hot flashes or flushing occur commonly in menopausal women. This is characterized by a sudden onset of warmth in the face and neck and often progressing to the chest. Such an episode generally lasts several minutes and is evidenced by a visible flushing of the skin. Often such episodes are accompanied by sweating, dizziness, nausea, palpitations and diaphoresis. Such symptoms can disrupt sleep and interfere with the quality of life. Although the cause of hot flashes are not completely understood, they are thought to be a disorder of thermoregulation resulting from a transient lowering of the hypothalamic temperature regulatory set point (Kronenberg et al., "Thermoregulatory Physiology of Menopausal Hot Flashes: A Review," Can. J. Physiol. Pharmacol., 65:1312-1324 (1987)). In post-menopausal woman, the cause of such hot flashes is believed to be a consequence of declining estrogen levels. Thus, it is not surprising that hot flashes also occur in a high percentage of women taking the anti-estrogen drug tamoxifen. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

•

Pharmaceutical preparations for treating side effects during and/or after GnRHa therapy Inventor(s): Oettel, Mcihael; (Jena, DE), Hummel, Wolfgang; (Neuenmarkt, DE), Dittrich, Ralph; (Erlangen, DE), Licht, Peter; (Bubenreuth, DE), Neuwinger, Joachim; (Erlangen, DE), Wildt, Ludwig; (Herzogenaurach-Haundorf, DE) Correspondence: STRIKER, STRIKER & STENBY; 103 East Neck Road; Huntington; NY; 11743; US Patent Application Number: 20020065260 Date filed: June 26, 2001 Abstract: The pharmaceutical preparations for treating side effects, such as hot flashes, prostate enlargement and gynecomastia, during and/or after treatment with analogs or antagonists of gonadotropin-releasing hormone (GnRHa therapy) contain an effective amount of a chemically modified derivative of 17.alpha.-estradiol, a chemically modified derivative of 17.beta.-estradiol and/or a chemical modified derivative of

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estriol. Pharmaceutical preparations containing 14.alpha.,15.alpha.-methylene-1,3,5(10),8-tetraene-3,17.alpha.-diol are particularly preferred. Excerpt(s): This application is a continuation-in-part of U.S. patent application Ser. No. 09/291,385, now abandoned, which, in turn, claims the benefit of U. S. Provisional Patent Application, Ser. No. 60/081,791, filed Apr. 15, 1998. The present invention relates to pharmaceutical preparations for reducing the undesirable side effects, such as hot flashes and prostate enlargement, during and/or after treatment with analogs or antagonists of gonadotropin-releasing hormone (GnRHa therapy) in men as well as women. The active ingredients in these pharmaceutical preparations are characterized by estrogen action in the central nervous system. The estrogen side effects in the periphery, e.g. the prostate, the uterus or the breast glands, are reduced or completely eliminated. It is known that treatment with analogs or antagonists of gonadotropinreleasing hormone (GnRHa therapy) is an effective therapy in diseases whose intensity is influenced by the activity of the gonads. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Selective estrogen receptor modulators in combination with estrogens Inventor(s): Labrie, Fernand; (Sainte-foy, CA) Correspondence: OSTROLENK FABER GERB & SOFFEN; 1180 AVENUE OF THE AMERICAS; NEW YORK; NY; 100368403 Patent Application Number: 20030065008 Date filed: May 9, 2002 Abstract: Novel methods for reduction or elimination the incidence of hot flashes and menopausal symptoms, while decreasing the risk of acquiring breast or endometrial cancer and furthermore treating and/or inhibiting the development of osteoporosis, hypercholesterolemia, hyperlipidemia, atherosclerosis, hypertension, insulin resistance, diabetes, loss of muscle mass, obesity, irregular menstruation, Alzheimer's disease, or vaginal dryness in susceptible warm-blooded animals including humans involving administration of selective estrogen receptor modulator, particularly compounds having the general structure 1and an amount of an estrogen or mixed estrogenic/androgenic compound. Further administration of bisphosphonates, or sex steroid precursor is specifically disclosed for the medical treatment and/or inhibition of development of some of these above-mentioned diseases. Pharmaceutical compositions for delivery of active ingredient(s) and kit(s) useful to the invention are also disclosed. Excerpt(s): This is a continuation of U.S. patent application Ser. No. 09/771,180, filed Jan. 26, 2001, which is based upon and claims priority of U.S. Provisional Application No. 60/178,601, filed Jan. 28, 2000, the contents of both of which are incorporated herein by reference. The present invention relates to novel combinations of physiologically active compounds. In particular, the combination includes a selective estrogen receptor modulator (SERM) in combination with an estrogen. In some embodiments, the combination includes a selective estrogen receptor modulator (SERM), an estrogen and a precursor of sex steroids or an androgenic compound. The invention also provides kits and pharmaceutical compositions for practicing the foregoing combination. Administering the foregoing combination to patients to reduce or eliminate the incidence of hot flashes, vasomotor symptoms, vaginal dryness or other menopausal symptoms. The risk of acquiring breast cancer and/or endometrial cancer is believed to be reduced for patients receiving this combination therapy. Methods of treating or

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reducing the likelihood of acquiring osteoporosis, hypercholesterolemia, hyperlipidemia, atherosclerosis, hypertension, Alzheimer's disease, insomnia, cardiovascular diseases, insulin resistance, diabetes, and obesity (especially abdominal obesity) is also provided. It is known that a large number of diseases, conditions and undesirable symptoms respond favorably to administering exogenous sex steroids, or precursors thereof. For example, estrogens are believed to decrease the rate of bone loss while androgens have been shown to build bone mass by stimulating bone formation. Hormone replacement therapy (e.g., administration of estrogens) may be used for the treatment of menopausal symptoms. Progestins are frequently used to counteract the endometrial proliferation and the risk of endometrial cancer induced by estrogens. Use of estrogens, androgenic compounds and/or progestins for treatment, or for prophylactic purposes, for a wide variety of symptoms and disorders suffer from a number of weaknesses. Treatment of females with androgenic compounds may have the undesirable side effect of causing certain masculinizing side effects. Also, administering sex steroids to patients may increase the patient's risk of acquiring certain diseases. Female breast cancer, for example, is exacerbated by estrogenic activity. Prostatic cancer and benign prostatic hyperplasia are both exacerbated by androgenic activity. 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 hot flashes, 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 “hot flashes” (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 hot flashes. You can also use this procedure to view pending patent applications concerning hot flashes. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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

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

The Bodywise Woman. 2nd. ed Source: Champaign, IL: Human Kinetics, 308 p., 1996. Contact: Human Kinetics, P.O. Box 5076, Champaign, IL 61825-5076. (800) 747-4457. Email: [email protected]. Summary: In seven chapters, this book covers the basic processes of a woman's life and how exercise can be included in each stage. Included are chapters on the history of women and exercise, body image, childbearing, aging, beginning exercise, fitness in children, and menstruation. The thesis of the authors is that exercise should be a part of every woman's life, and it can help ease a variety of physical problems, from difficult periods to depression to the hot flashes of menopause.

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•

Whose body is it anyway? Smart alternative and traditional health choices for your total well-being Source: New York, NY: Newmarket Press. 1999. 335 pp. Contact: Available from Newmarket Press, 18 East 48th Street, New York, NY 10017. Telephone: (212) 832-3575. $24.95. Summary: This book contains information on traditional and alternative treatment options for women' s health issues over the age of 35. Topics include menopause, hormone replacement therapies, hot flashes, incontinence, sexual activity, heart disease and breast cancer, osteoporosis, and healthy lifestyle practices in nutrition, exercise, healthy habits, and other topics. The second part contains checklists and questionnaires for self evaluation, resource listings, a glossary, references, and an index.

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

Death in a Hot Flash by Jane Isenberg (Author); ISBN: 0380802813; http://www.amazon.com/exec/obidos/ASIN/0380802813/icongroupinterna

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From Hot Flashes To Power Surges by Judy Pettigrew, Diane Simpson; ISBN: 0962289949; http://www.amazon.com/exec/obidos/ASIN/0962289949/icongroupinterna

•

Get Off the Menopause Roller Coaster: Natural Solutions for Mood Swings, Hot Flashes, Fatigue, Anxiety, Depression, and Other Symptons by Shari, Phd Lieberman; ISBN: 1583330003; http://www.amazon.com/exec/obidos/ASIN/1583330003/icongroupinterna

•

Helga Hanson's Hot Flash Handbook by Martin House (1997); ISBN: 1886627045; http://www.amazon.com/exec/obidos/ASIN/1886627045/icongroupinterna

•

Hormones Hot Flashes by Clark Gillespie (Author) (1994); ISBN: 006095017X; http://www.amazon.com/exec/obidos/ASIN/006095017X/icongroupinterna

•

Hormones, Hot Flashes, and Mood Swings by Clark Gillespie; ISBN: 0060963557; http://www.amazon.com/exec/obidos/ASIN/0060963557/icongroupinterna

•

Hot Cider, Hot Cocoa and Hot Flashes: Maxine's Guide to the Holidays by John M. Wagner (Illustrator), Chris Brethwaite; ISBN: 0836221923; http://www.amazon.com/exec/obidos/ASIN/0836221923/icongroupinterna

•

Hot Flash Cookbook: Delicious Recipes for Health and Well-Being by Cathy Luchetti, et al (2003); ISBN: 0811840085; http://www.amazon.com/exec/obidos/ASIN/0811840085/icongroupinterna

Books

85

•

Hot Flashes by Richard Stevenson; ISBN: 1896860966; http://www.amazon.com/exec/obidos/ASIN/1896860966/icongroupinterna

•

Hot Flashes [LARGE PRINT] by Barbara Raskin; ISBN: 1555046517; http://www.amazon.com/exec/obidos/ASIN/1555046517/icongroupinterna

•

Hot Flashes from Abroad 2 Ed: Women's Travel Tales and Adventures by Jean Gould (Editor); ISBN: 1580050557; http://www.amazon.com/exec/obidos/ASIN/1580050557/icongroupinterna

•

Hot Flashes Warm Bottles : First-Time Mothers Over Forty by Nancy London (2001); ISBN: 0890879710; http://www.amazon.com/exec/obidos/ASIN/0890879710/icongroupinterna

•

Hot Flashes: Women Writers on the Change of Life by Lynne Taetzsch (Editor); ISBN: 0571198716; http://www.amazon.com/exec/obidos/ASIN/0571198716/icongroupinterna

•

No More Hot Flashes and Other Good News by Penny Wise Budoff (1990); ISBN: 0446358797; http://www.amazon.com/exec/obidos/ASIN/0446358797/icongroupinterna

•

No More Hot Flashes.And Even More Good News by Penny Wise Budoff (Author) (1999); ISBN: 0446607800; http://www.amazon.com/exec/obidos/ASIN/0446607800/icongroupinterna

•

Sinkin Spells, Hot Flashes, Fits and Cravins by Ernest Matthew Mickler; ISBN: 0898152690; http://www.amazon.com/exec/obidos/ASIN/0898152690/icongroupinterna

•

The Hot Flash Club by Nancy Thayer (2003); ISBN: 0345468627; http://www.amazon.com/exec/obidos/ASIN/0345468627/icongroupinterna

•

The Hot Flash Cookbook by Cathy Luchetti, Linda Hillel (1997); ISBN: 0811815404; http://www.amazon.com/exec/obidos/ASIN/0811815404/icongroupinterna

•

Users Guide to Easing Menopause Symptoms Naturally: Learn How to Prevent Hot Flashes and Other Symptoms Safely and Naturally by Cynthia M. Watson (2003); ISBN: 1591200954; http://www.amazon.com/exec/obidos/ASIN/1591200954/icongroupinterna

•

Wise Women Don't Have Hot Flashes They Have Power Surges! by D. Reid Wallace; ISBN: 0965282309; http://www.amazon.com/exec/obidos/ASIN/0965282309/icongroupinterna

The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “hot flashes” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:8 8

In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is currently adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic

86 Hot Flashes

•

No more hot flashes, and other good news Author: Budoff, Penny Wise,; Year: 1983; New York: Putnam's, c1983; ISBN: 0399127933 http://www.amazon.com/exec/obidos/ASIN/0399127933/icongroupinterna

Chapters on Hot Flashes In order to find chapters that specifically relate to hot flashes, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and hot flashes 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 “hot flashes” (or synonyms) into the “For these words:” box.

database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a "Books" button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.

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

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

Hot flash on menopause [videorecording] Source: [presented by] Filmakers Library; produced and distributed by Canadian Broadcasting Corporation; Year: 1999; Format: Videorecording; New York, NY: Filmakers Library, c1998

89

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

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

Red clover no relief for hot flashes-U.S.study Source: Reuters Health eLine Date: July 08, 2003

•

Paroxetine CR reduces menopausal hot flashes Source: Reuters Industry Breifing Date: June 03, 2003

90 Hot Flashes

•

Antidepressant helps relieve hot flashes: US study Source: Reuters Health eLine Date: June 03, 2003

•

Plant estrogens don't cool hot flashes: study Source: Reuters Health eLine Date: June 02, 2003

•

Paroxetine reduces number and severity of menopausal hot flashes Source: Reuters Industry Breifing Date: May 02, 2003

•

More evidence antidepressants cool hot flashes Source: Reuters Health eLine Date: May 02, 2003

•

FDA reconsidering efficacy of estrogen-androgen therapy for hot flashes Source: Reuters Industry Breifing Date: April 10, 2003

•

FDA questions hormone therapy for hot flashes Source: Reuters Health eLine Date: April 10, 2003

•

Smoking and obesity increase risk of severe hot flashes Source: Reuters Medical News Date: February 07, 2003

•

Gabapentin reduces frequency and severity of hot flashes Source: Reuters Medical News Date: February 07, 2003

•

Seizure medication turns down hot flashes Source: Reuters Health eLine Date: February 03, 2003

•

Smoking, obesity up women's hot flashes: study Source: Reuters Health eLine Date: January 31, 2003

•

Gabapentin may relieve hot flashes Source: Reuters Industry Breifing Date: December 05, 2002

•

Paroxetine reduces menopausal hot flashes Source: Reuters Industry Breifing Date: October 30, 2002

•

Soy drink does not relieve hot flashes in breast cancer survivors Source: Reuters Medical News Date: April 12, 2002

•

Soy doesn't ease cancer survivors' hot flashes Source: Reuters Health eLine Date: April 12, 2002

•

Antidepressant shown to reduce hot flashes Source: Reuters Health eLine Date: March 20, 2002

Periodicals and News

•

Fluoxetine improves hot flashes in women with breast cancer risk Source: Reuters Industry Breifing Date: March 14, 2002

•

Herb little help for hot flashes in breast cancer Source: Reuters Health eLine Date: May 17, 2001

•

Soy product consumption seems to protect against hot flashes Source: Reuters Medical News Date: April 27, 2001

•

Hot flash: vitamin E may help Source: Reuters Health eLine Date: April 06, 2001

•

Gabapentin relieves menopausal and drug-induced hot flashes Source: Reuters Medical News Date: June 13, 2000

•

Hot flashes relieved by epilepsy drug Source: Reuters Health eLine Date: June 12, 2000

•

Venlafaxine reduces hot flashes in breast cancer patients Source: Reuters Medical News Date: May 24, 2000

•

Antidepressant relieves hot flashes Source: Reuters Health eLine Date: May 23, 2000

•

Drug may ease hot flashes in breast cancer patients Source: Reuters Health eLine Date: May 18, 2000

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The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name.

92 Hot Flashes

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 “hot flashes” (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 “hot flashes” (or synonyms). If you know the name of a company that is relevant to hot flashes, 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 “hot flashes” (or synonyms).

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

Menopausal Weight Gain Source: Mayo Clinic Women's HealthSource. December 1998. Contact: Mayo Clinic Women's HealthSource, P.O. Box 56931, Boulder, CO 80322-6931. Summary: This article discusses the changes a woman can expect to go through during perimenopause and menopause. The author points out the changes of puberty and pregnancy as models for the change of menopause. According to the author, lowered estrogen production contributes to the mood swings, sleep disturbances, and hot flashes of menopause. For most women, their metabolism also slows down, and their lean muscle mass diminishes. This can lead to weight gain. A starvation diet is not the

Periodicals and News

93

answer, according to the author, who says that exercise is a better choice. Exercise boosts the metabolism, burns fat, and can strengthen bones. All forms of exercise are potentially beneficial, including aerobic exercise to burn fat, stretching to increase flexibility, and strength training to improve muscle mass and strengthen bones. Other topics discussed include hormone replacement therapy and a healthy diet.

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

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CHAPTER 10. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.

U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for hot flashes. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a nonprofit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DI Advice for the Patient can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with hot flashes. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The

96 Hot Flashes

following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to hot flashes: Androgens and Estrogens •

Systemic - U.S. Brands: Andrest 90-4; Andro-Estro 90-4; Androgyn L.A.; DeComberol; Deladumone; Delatestadiol; depAndrogyn; Depo-Testadiol; Depotestogen; Duo-Cyp; Duo-Gen L.A.; Dura-Dumone 90/4; Duratestin; Estratest; Estratest H.S.; Halodrin; Menoject-L.A.; OB; Premarin with http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202037.html

Conjugated Estrogens and Medroxyprogesterone for Ovarian Hormone Therapy (Oht) •

Systemic - U.S. Brands: Note: http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/209441.html

Ergotamine, Belladonna Alkaloids, and Phenobarbital •

Systemic - U.S. Brands: Bellergal-S http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202217.html

Estrogens •

Systemic - U.S. Brands: Alora; Aquest; Climara; Clinagen LA 40; Delestrogen; depGynogen; Depo-Estradiol; Depogen; Dioval 40; Dioval XX; Dura-Estrin; Duragen-20; E-Cypionate; Estinyl; Estrace; Estraderm; Estragyn 5; Estragyn LA 5; Estra-L 40; Estratab; Estro-A; Estro-Cyp; Estro http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202226.html

Estrogens and Progestins (Ovarian Hormone Therapy) •

Systemic - U.S. Brands: Activella; Note: http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500070.html

Goserelin •

Systemic - U.S. Brands: Zoladex http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202267.html

Leuprolide •

Systemic - U.S. Brands: Lupron; Viadur http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202322.html

Raloxifene •

Systemic - U.S. Brands: Evista http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203396.html

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.

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97

Mosby’s Drug Consult Mosby’s Drug Consult database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/. PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html. Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee. If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

99

APPENDICES

101

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 Institute9: •

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/

9

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

102 Hot Flashes

•

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.10 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:11 •

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

10

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). 11 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 Gateway12 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.13 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “hot flashes” (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 887 17 776 3 1 1684

HSTAT14 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.15 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.16 Simply search by “hot flashes” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

12

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

13

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). 14 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 15 16

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 Biologists17 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.18 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.19 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/.

17 Adapted 18

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. 19 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 hot flashes can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to hot flashes. 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 hot flashes. 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 “hot flashes”:

108 Hot Flashes

•

Other guides Breast Cancer http://www.nlm.nih.gov/medlineplus/breastcancer.html Disasters and Emergency Preparedness http://www.nlm.nih.gov/medlineplus/disastersandemergencypreparedness.html Hormone Replacement Therapy http://www.nlm.nih.gov/medlineplus/hormonereplacementtherapy.html Menopause http://www.nlm.nih.gov/medlineplus/menopause.html Menopause http://www.nlm.nih.gov/medlineplus/tutorials/menopauseloader.html Menstruation and Premenstrual Syndrome http://www.nlm.nih.gov/medlineplus/menstruationandpremenstrualsyndrome.ht l Osteoporosis http://www.nlm.nih.gov/medlineplus/osteoporosis.html

Within the health topic page dedicated to hot flashes, the following was listed: •

General/Overview Menopause http://www.nlm.nih.gov/medlineplus/tutorials/menopauseloader.html Menopause Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=DS00119 Menopause Source: National Women's Health Information Center http://www.4woman.gov/Menopause/menopause.cfm?page=335&mtitle=menop ause Menopause Years Source: American College of Obstetricians and Gynecologists http://www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZZ6CGQV77C& sub_cat=327 Menopause: What to Expect When Your Body Is Changing Source: American Academy of Family Physicians http://familydoctor.org/healthfacts/125/index.html

•

Diagnosis/Symptoms Estrogen Tests Source: American Association for Clinical Chemistry http://www.labtestsonline.org/understanding/analytes/estrogen/test.html

Patient Resources

•

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Treatment FDA Approves Estrasorb for Treatment of Menopausal Hot Flashes Source: Food and Drug Administration http://www.fda.gov/bbs/topics/ANSWERS/2003/ANS01255.html MEDLINEplus: Hormone Replacement Therapy Source: National Library of Medicine http://www.nlm.nih.gov/medlineplus/hormonereplacementtherapy.html Menopausal Hormone Use: Questions and Answers Source: National Cancer Institute http://www.cancer.gov/newscenter/estrogenplus

•

Alternative Therapy Herbal Products for Menopause Source: American College of Obstetricians and Gynecologists http://www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZZSPYZT5FD& sub_cat=2002 Hot Flashes: Treatments Are Available Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=HQ01409 Questions and Answers About Black Cohosh and the Symptoms of Menopause Source: National Center for Complementary and Alternative Medicine, National Institutes of Health, Office of Dietary Supplements http://ods.od.nih.gov/factsheets/blackcohosh.html

•

Specific Conditions/Aspects JAMA Patient Page: Perimenopause: Beginning of Menopause Source: American Medical Association http://www.ama-assn.org/public/journals/patient/archive/jpg021903.htm Menopause and Bladder Control http://kidney.niddk.nih.gov/kudiseases/pubs/menopause_ez/index.htm Menopause and Diabetes Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=DA00038 Menopause and the Risk of Heart Disease and Stroke Source: American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=4658 Perimenopause Source: National Women's Health Information Center http://www.4woman.gov/Menopause/menopause.cfm?page=336&mtitle=perime nopause Perimenopause: A Period Before Your Period Ends Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=HQ01199

110 Hot Flashes

Talking to Your Health Care Provider about Menopause Source: National Women's Health Information Center http://www.4woman.gov/Menopause/menopause.cfm?page=337&mtitle=postme nopause Very-Low-Dose Birth Control Pills for Perimenopausal Women Source: American Academy of Family Physicians http://familydoctor.org/handouts/326.html Weight Gain As You Age Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=HQ01076 •

From the National Institutes of Health Menopause Source: National Institute on Aging http://www.niapublications.org/engagepages/menopause.asp Menopause Source: National Institute on Aging http://www.niapublications.org/pubs/menopause/index.asp

•

Latest News FDA Approves Estrasorb for Treatment of Menopausal Hot Flashes Source: 10/10/2003, Food and Drug Administration http://www.fda.gov/bbs/topics/ANSWERS/2003/ANS01255.html Four Shots a Year May Curb Menopausal Bone Loss Source: 10/08/2003, Reuters Health http://www.nlm.nih.gov//www.nlm.nih.gov/medlineplus/news/fullstory_14223 .html

•

Organizations Hormone Foundation http://www.hormone.org/ National Institute on Aging http://www.nia.nih.gov/ National Women's Health Information Center Source: Dept. of Health and Human Services http://www.4woman.org/ North American Menopause Society http://www.menopause.org/

•

Research FDA Revises Finding on Estrogen/Androgen Combination Products in the Treatment of Hot Flashes Source: Food and Drug Administration http://www.fda.gov/bbs/topics/ANSWERS/2003/ANS01210.html

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Hormone Therapy Can Relieve Menopause-Type Symptoms Common in Elderly Women: HERS Study Report Source: American College of Obstetricians and Gynecologists http://www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZZRMBOL19D &sub_cat=2 NHLBI Stops Trial of Estrogen Plus Progestin Due to Increased Breast Cancer Risk, Lack of Overall Benefit Source: National Heart, Lung, and Blood Institute http://www.nih.gov/news/pr/jul2002/nhlbi-09.htm Relationship between Use of Cholesterol-Lowering Drugs (Statins) and Osteoporosis in Women after Menopause Source: American College of Physicians http://www.annals.org/cgi/content/full/139/2/I-27 Women Urged to Reduce Heart Disease Risk Before Menopause Source: American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=3009770 Women with Premature Menopause at Increased Risk for Potentially Fatal Adrenal Condition: Early Diagnosis Can Lead to Effective Treatment Source: National Institute of Child Health and Human Development http://www.nih.gov/news/pr/aug2002/nichd-30.htm You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The 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 hot flashes. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources

A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

112 Hot Flashes

•

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 hot flashes. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with hot flashes. 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 hot flashes. 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 “hot flashes” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit

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your search to “Organizations” and “hot flashes”. 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 “hot flashes” (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 “hot flashes” (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.20

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

20

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)21: •

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/

21

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

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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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

120 Hot Flashes

•

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

•

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

•

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

•

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

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

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

•

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

•

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

•

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

•

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

•

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

•

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

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

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

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

•

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

•

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

•

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

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HOT FLASHES DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. 5-Hydroxytryptophan: Precursor of serotonin used as antiepileptic and antidepressant. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Aberrant: Wandering or deviating from the usual or normal course. [EU] Ablation: The removal of an organ by surgery. [NIH] Acceptor: A substance which, while normally not oxidized by oxygen or reduced by hydrogen, can be oxidized or reduced in presence of a substance which is itself undergoing oxidation or reduction. [NIH] Acne: A disorder of the skin marked by inflammation of oil glands and hair glands. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adrenal Medulla: The inner part of the adrenal gland; it synthesizes, stores and releases catecholamines. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerobic: In biochemistry, reactions that need oxygen to happen or happen when oxygen is present. [NIH] 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] Aetiology: Study of the causes of disease. [EU] 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] Agenesis: Lack of complete or normal development; congenital absence of an organ or part. [NIH]

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Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Airway: A device for securing unobstructed passage of air into and out of the lungs during general anesthesia. [NIH] Alfalfa: A deep-rooted European leguminous plant (Medicago sativa) widely grown for hay and forage. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alkaline: Having the reactions of an alkali. [EU] 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] 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] Ameliorated: A changeable condition which prevents the consequence of a failure or accident from becoming as bad as it otherwise would. [NIH] Ameliorating: A changeable condition which prevents the consequence of a failure or accident from becoming as bad as it otherwise would. [NIH] Amenorrhea: Absence of menstruation. [NIH] Amino acid: Any organic compound containing an amino (-NH2 and a carboxyl (- COOH) group. The 20 a-amino acids listed in the accompanying table are the amino acids from 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] Amoxicillin: A broad-spectrum semisynthetic antibiotic similar to ampicillin except that its resistance to gastric acid permits higher serum levels with oral administration. [NIH] Ampicillin: Semi-synthetic derivative of penicillin that functions as an orally active broadspectrum antibiotic. [NIH] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Analytes: A component of a test sample the presence of which has to be demonstrated. The term "analyte" includes where appropriate formed from the analyte during the analyses. [NIH]

Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Androgenic: Producing masculine characteristics. [EU] Androgens: A class of sex hormones associated with the development and maintenance of

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the secondary male sex characteristics, sperm induction, and sexual differentiation. In addition to increasing virility and libido, they also increase nitrogen and water retention and stimulate skeletal growth. [NIH] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] 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] 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] Anomalies: Birth defects; abnormalities. [NIH] Anorexia: Lack or loss of appetite for food. Appetite is psychologic, dependent on memory and associations. Anorexia can be brought about by unattractive food, surroundings, or company. [NIH] Anthraquinones: An anthracene ring which contains two ketone moieties in any position. Can be substituted in any position except on the ketone groups. [NIH] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticoagulant: A drug that helps prevent blood clots from forming. Also called a blood thinner. [NIH] Anticonvulsant: An agent that prevents or relieves convulsions. [EU] Antidepressant: A drug used to treat depression. [NIH] Antiepileptic: An agent that combats epilepsy. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Anti-infective: An agent that so acts. [EU] Anti-Infective Agents: Substances that prevent infectious agents or organisms from spreading or kill infectious agents in order to prevent the spread of infection. [NIH] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Antineoplastic: Inhibiting or preventing the development of neoplasms, checking the

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maturation and proliferation of malignant cells. [EU] Antioxidant: A substance that prevents damage caused by free radicals. Free radicals are highly reactive chemicals that often contain oxygen. They are produced when molecules are split to give products that have unpaired electrons. This process is called oxidation. [NIH] Antispasmodic: An agent that relieves spasm. [EU] Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Aplastic anemia: A condition in which the bone marrow is unable to produce blood cells. [NIH]

Apnea: A transient absence of spontaneous respiration. [NIH] Apolipoproteins: The protein components of lipoproteins which remain after the lipids to which the proteins are bound have been removed. They play an important role in lipid transport and metabolism. [NIH] Aqueous: Having to do with water. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Aspirate: Fluid withdrawn from a lump, often a cyst, or a nipple. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] ATP: ATP an abbreviation for adenosine triphosphate, a compound which serves as a carrier of energy for cells. [NIH] 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] Autonomic: Self-controlling; functionally independent. [EU] Axillary: Pertaining to the armpit area, including the lymph nodes that are located there. [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] Basal Ganglia: Large subcortical nuclear masses derived from the telencephalon and located in the basal regions of the cerebral hemispheres. [NIH] Basal Ganglia Diseases: Diseases of the basal ganglia including the putamen; globus pallidus; claustrum; amygdala; and caudate nucleus. Dyskinesias (most notably involuntary movements and alterations of the rate of movement) represent the primary clinical manifestations of these disorders. Common etiologies include cerebrovascular disease; neurodegenerative diseases; and craniocerebral trauma. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Basophils: Granular leukocytes characterized by a relatively pale-staining, lobate nucleus and cytoplasm containing coarse dark-staining granules of variable size and stainable by basic dyes. [NIH]

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Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Benign prostatic hyperplasia: A benign (noncancerous) condition in which an overgrowth of prostate tissue pushes against the urethra and the bladder, blocking the flow of urine. Also called benign prostatic hypertrophy or BPH. [NIH] Benzene: Toxic, volatile, flammable liquid hydrocarbon biproduct of coal distillation. It is used as an industrial solvent in paints, varnishes, lacquer thinners, gasoline, etc. Benzene causes central nervous system damage acutely and bone marrow damage chronically and is carcinogenic. It was formerly used as parasiticide. [NIH] Bilateral: Affecting both the right and left side of body. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biomarkers: Substances sometimes found in an increased amount in the blood, other body fluids, or tissues and that may suggest the presence of some types of cancer. Biomarkers include CA 125 (ovarian cancer), CA 15-3 (breast cancer), CEA (ovarian, lung, breast, pancreas, and GI tract cancers), and PSA (prostate cancer). Also called tumor markers. [NIH] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Biotransformation: The chemical alteration of an exogenous substance by or in a biological system. The alteration may inactivate the compound or it may result in the production of an active metabolite of an inactive parent compound. The alteration may be either nonsynthetic (oxidation-reduction, hydrolysis) or synthetic (glucuronide formation, sulfate conjugation, acetylation, methylation). This also includes metabolic detoxication and clearance. [NIH] Bipolar Disorder: A major affective disorder marked by severe mood swings (manic or major depressive episodes) and a tendency to remission and recurrence. [NIH] Bladder: The organ that stores urine. [NIH] Blister: Visible accumulations of fluid within or beneath the epidermis. [NIH] Blister pack: A package consisting of a clear plastic overlay affixed to a cardboard backing for protecting and displaying a product. [EU] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood Glucose: Glucose in blood. [NIH] Blood Platelets: Non-nucleated disk-shaped cells formed in the megakaryocyte and found in the blood of all mammals. They are mainly involved in blood coagulation. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH]

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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 Image: Individuals' personal concept of their bodies as objects in and bound by space, independently and apart from all other objects. [NIH] Bone Density: The amount of mineral per square centimeter of bone. This is the definition used in clinical practice. Actual bone density would be expressed in grams per milliliter. It is most frequently measured by photon absorptiometry or x-ray computed tomography. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bone metastases: Cancer that has spread from the original (primary) tumor to the bone. [NIH]

Bone Resorption: Bone loss due to osteoclastic activity. [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] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Breakdown: A physical, metal, or nervous collapse. [NIH] Broad-spectrum: Effective against a wide range of microorganisms; said of an antibiotic. [EU] Bromine: A halogen with the atomic symbol Br, atomic number 36, and atomic weight 79.904. It is a volatile reddish-brown liquid that gives off suffocating vapors, is corrosive to the skin, and may cause severe gastroenteritis if ingested. [NIH] Burns: Injuries to tissues caused by contact with heat, steam, chemicals (burns, chemical), electricity (burns, electric), or the like. [NIH] Burns, Electric: Burns produced by contact with electric current or from a sudden discharge of electricity. [NIH] Calcifediol: The major circulating metabolite of vitamin D3 produced in the liver and the best indicator of the body's vitamin D stores. It is effective in the treatment of rickets and osteomalacia, both in azotemic and non-azotemic patients. Calcifediol also has mineralizing properties. [NIH] Calcitonin: A peptide hormone that lowers calcium concentration in the blood. In humans, it is released by thyroid cells and acts to decrease the formation and absorptive activity of osteoclasts. Its role in regulating plasma calcium is much greater in children and in certain diseases than in normal adults. [NIH] Calcitonin Gene-Related Peptide: Calcitonin gene-related peptide. A 37-amino acid peptide derived from the calcitonin gene. It occurs as a result of alternative processing of mRNA from the calcitonin gene. The neuropeptide is widely distributed in neural tissue of the brain, gut, perivascular nerves, and other tissue. The peptide produces multiple biological effects and has both circulatory and neurotransmitter modes of action. In particular, it is a potent endogenous vasodilator. [NIH] Calcitriol: The physiologically active form of vitamin D. It is formed primarily in the kidney

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by enzymatic hydroxylation of 25-hydroxycholecalciferol (calcifediol). Its production is stimulated by low blood calcium levels and parathyroid hormone. Calcitriol increases intestinal absorption of calcium and phosphorus, and in concert with parathyroid hormone increases bone resorption. [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] Calcium Channels: Voltage-dependent cell membrane glycoproteins selectively permeable to calcium ions. They are categorized as L-, T-, N-, P-, Q-, and R-types based on the activation and inactivation kinetics, ion specificity, and sensitivity to drugs and toxins. The L- and T-types are present throughout the cardiovascular and central nervous systems and the N-, P-, Q-, & R-types are located in neuronal tissue. [NIH] Carcinogenesis: The process by which normal cells are transformed into cancer cells. [NIH] Carcinogenic: Producing carcinoma. [EU] Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs. [NIH]

Cardiac: Having to do with the heart. [NIH] Cardiorespiratory: Relating to the heart and lungs and their function. [EU] 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] Cassia: Leguminous plants Cassia senna L. (or C. acutifolia) and C. angustifolia that contain anthraquinones which are used as laxatives. [NIH] Castration: Surgical removal or artificial destruction of gonads. [NIH] Cataracts: In medicine, an opacity of the crystalline lens of the eye obstructing partially or totally its transmission of light. [NIH] Catecholamine: A group of chemical substances manufactured by the adrenal medulla and secreted during physiological stress. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Division: The fission of a cell. [NIH] Cell membrane: Cell membrane = plasma membrane. The structure enveloping a cell, enclosing the cytoplasm, and forming a selective permeability barrier; it consists of lipids, proteins, and some carbohydrates, the lipids thought to form a bilayer in which integral proteins are embedded to varying degrees. [EU] Cell proliferation: An increase in the number of cells as a result of cell growth and cell division. [NIH] Cellulose: A polysaccharide with glucose units linked as in cellobiose. It is the chief constituent of plant fibers, cotton being the purest natural form of the substance. As a raw material, it forms the basis for many derivatives used in chromatography, ion exchange materials, explosives manufacturing, and pharmaceutical preparations. [NIH]

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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] Cerebellum: Part of the metencephalon that lies in the posterior cranial fossa behind the brain stem. It is concerned with the coordination of movement. [NIH] 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] Character: In current usage, approximately equivalent to personality. The sum of the relatively fixed personality traits and habitual modes of response of an individual. [NIH] Chemoprevention: The use of drugs, vitamins, or other agents to try to reduce the risk of, or delay the development or recurrence of, cancer. [NIH] Chemotherapy: Treatment with anticancer drugs. [NIH] Chin: The anatomical frontal portion of the mandible, also known as the mentum, that contains the line of fusion of the two separate halves of the mandible (symphysis menti). This line of fusion divides inferiorly to enclose a triangular area called the mental protuberance. On each side, inferior to the second premolar tooth, is the mental foramen for the passage of blood vessels and a nerve. [NIH] Chlorine: A greenish-yellow, diatomic gas that is a member of the halogen family of elements. It has the atomic symbol Cl, atomic number 17, and atomic weight 70.906. It is a powerful irritant that can cause fatal pulmonary edema. Chlorine is used in manufacturing, as a reagent in synthetic chemistry, for water purification, and in the production of chlorinated lime, which is used in fabric bleaching. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Cholesterol Esters: Fatty acid esters of cholesterol which constitute about two-thirds of the cholesterol in the plasma. The accumulation of cholesterol esters in the arterial intima is a characteristic feature of atherosclerosis. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chylomicrons: A class of lipoproteins that carry dietary cholesterol and triglycerides from the small intestines to the tissues. [NIH] Ciprofloxacin: A carboxyfluoroquinoline antimicrobial agent that is effective against a wide range of microorganisms. It has been successfully and safely used in the treatment of resistant respiratory, skin, bone, joint, gastrointestinal, urinary, and genital infections. [NIH] Circadian: Repeated more or less daily, i. e. on a 23- to 25-hour cycle. [NIH] Circadian Rhythm: The regular recurrence, in cycles of about 24 hours, of biological processes or activities, such as sensitivity to drugs and stimuli, hormone secretion, sleeping, feeding, etc. This rhythm seems to be set by a 'biological clock' which seems to be set by recurring daylight and darkness. [NIH] Climacteric: Physiologic period, characterized by endocrine, somatic, and psychic changes

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with the termination of ovarian function in the female. It may also accompany the normal diminution of sexual activity in the male. [NIH] Clinical Medicine: The study and practice of medicine by direct examination of the patient. [NIH]

Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] 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] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Cognition: Intellectual or mental process whereby an organism becomes aware of or obtains knowledge. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Collapse: 1. A state of extreme prostration and depression, with failure of circulation. 2. Abnormal falling in of the walls of any part of organ. [EU] Combination Therapy: Association of 3 drugs to treat AIDS (AZT + DDC or DDI + protease inhibitor). [NIH] Comet Assay: A genotoxicological technique for measuring DNA damage in an individual cell using single-cell gel electrophoresis. Cell DNA fragments assume a "comet with tail" formation on electrophoresis and are detected with an image analysis system. Alkaline assay conditions facilitate sensitive detection of single-strand damage. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with

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lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Compliance: Distensibility measure of a chamber such as the lungs (lung compliance) or bladder. Compliance is expressed as a change in volume per unit change in pressure. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Confounding: Extraneous variables resulting in outcome effects that obscure or exaggerate the "true" effect of an intervention. [NIH] Conjugated: Acting or operating as if joined; simultaneous. [EU] 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] Constipation: Infrequent or difficult evacuation of feces. [NIH] Consumption: Pulmonary tuberculosis. [NIH] Contraception: Use of agents, devices, methods, or procedures which diminish the likelihood of or prevent conception. [NIH] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH] Controlled clinical trial: A clinical study that includes a comparison (control) group. The comparison group receives a placebo, another treatment, or no treatment at all. [NIH]

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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] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary heart disease: A type of heart disease caused by narrowing of the coronary arteries that feed the heart, which needs a constant supply of oxygen and nutrients carried by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by fat and cholesterol deposits and cannot supply enough blood to the heart, CHD results. [NIH] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] 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] Cortices: The outer layer of an organ; used especially of the cerebrum and cerebellum. [NIH] Corticosteroids: Hormones that have antitumor activity in lymphomas and lymphoid leukemias; in addition, corticosteroids (steroids) may be used for hormone replacement and for the management of some of the complications of cancer and its treatment. [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] 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] Cyproterone: An anti-androgen that, in the form of its acetate, also has progestational properties. It is used in the treatment of hypersexuality in males, as a palliative in prostatic carcinoma, and, in combination with estrogen, for the therapy of severe acne and hirsutism in females. [NIH] Cyproterone Acetate: An agent with anti-androgen and progestational properties. It shows competitive binding with dihydrotestosterone at androgen receptor sites. [NIH] Cyst: A sac or capsule filled with fluid. [NIH] Cytochrome: Any electron transfer hemoprotein having a mode of action in which the transfer of a single electron is effected by a reversible valence change of the central iron atom of the heme prosthetic group between the +2 and +3 oxidation states; classified as cytochromes a in which the heme contains a formyl side chain, cytochromes b, which contain protoheme or a closely similar heme that is not covalently bound to the protein,

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cytochromes c in which protoheme or other heme is covalently bound to the protein, and cytochromes d in which the iron-tetrapyrrole has fewer conjugated double bonds than the hemes have. Well-known cytochromes have been numbered consecutively within groups and are designated by subscripts (beginning with no subscript), e.g. cytochromes c, c1, C2, . New cytochromes are named according to the wavelength in nanometres of the absorption maximum of the a-band of the iron (II) form in pyridine, e.g., c-555. [EU] Danazol: A synthetic steroid with antigonadotropic and anti-estrogenic activities that acts as an anterior pituitary suppressant by inhibiting the pituitary output of gonadotropins. It possesses some androgenic properties. Danazol has been used in the treatment of endometriosis and some benign breast disorders. [NIH] Data Collection: Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dehydroepiandrosterone: DHEA. A substance that is being studied as a cancer prevention drug. It belongs to the family of drugs called steroids. [NIH] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Dental Caries: Localized destruction of the tooth surface initiated by decalcification of the enamel followed by enzymatic lysis of organic structures and leading to cavity formation. If left unchecked, the cavity may penetrate the enamel and dentin and reach the pulp. The three most prominent theories used to explain the etiology of the disase are that acids produced by bacteria lead to decalcification; that micro-organisms destroy the enamel protein; or that keratolytic micro-organisms produce chelates that lead to decalcification. [NIH]

Dental implant: A small metal pin placed inside the jawbone to mimic the root of a tooth. Dental implants can be used to help anchor a false tooth or teeth, or a crown or bridge. [NIH] Dentists: Individuals licensed to practice dentistry. [NIH] Deprivation: Loss or absence of parts, organs, powers, or things that are needed. [EU] Dermis: A layer of vascular connective tissue underneath the epidermis. The surface of the dermis contains sensitive papillae. Embedded in or beneath the dermis are sweat glands, hair follicles, and sebaceous glands. [NIH] Deuterium: Deuterium. The stable isotope of hydrogen. It has one neutron and one proton in the nucleus. [NIH] Developed Countries: Countries that have reached a level of economic achievement through an increase of production, per capita income and consumption, and utilization of natural and human resources. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diaphoresis: Perspiration, especially profuse perspiration. Called also sudoresis. [EU] Diastolic: Of or pertaining to the diastole. [EU] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Dihydrotestosterone: Anabolic agent. [NIH]

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Diploid: Having two sets of chromosomes. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] 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] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] DNA Topoisomerase: An enzyme catalyzing ATP-independent breakage of single-stranded DNA, followed by passage and rejoining of another single-stranded DNA. This enzyme class brings about the conversion of one topological isomer of DNA into another, e.g., the relaxation of superhelical turns in DNA, the interconversion of simple and knotted rings of single-stranded DNA, and the intertwisting of single-stranded rings of complementary sequences. (From Enzyme Nomenclature, 1992) EC 5.99.1.2. [NIH] Domesticated: Species in which the evolutionary process has been influenced by humans to meet their needs. [NIH] Dopamine: An endogenous catecholamine and prominent neurotransmitter in several systems of the brain. In the synthesis of catecholamines from tyrosine, it is the immediate precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. A family of dopaminergic receptor subtypes mediate its action. Dopamine is used pharmacologically for its direct (beta adrenergic agonist) and indirect (adrenergic releasing) sympathomimetic effects including its actions as an inotropic agent and as a renal vasodilator. [NIH] Double-blind: Pertaining to a clinical trial or other experiment in which neither the subject nor the person administering treatment knows which treatment any particular subject is receiving. [EU] Double-blinded: A clinical trial in which neither the medical staff nor the person knows which of several possible therapies the person is receiving. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Duodenum: The first part of the small intestine. [NIH] Dysmenorrhea: Painful menstruation. [NIH] Dyspareunia: Painful sexual intercourse. [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] Electrocoagulation: Electrosurgical procedures used to treat hemorrhage (e.g., bleeding ulcers) and to ablate tumors, mucosal lesions, and refractory arrhythmias. [NIH]

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Electrophoresis: An electrochemical process in which macromolecules or colloidal particles with a net electric charge migrate in a solution under the influence of an electric current. [NIH]

Emesis: Vomiting; an act of vomiting. Also used as a word termination, as in haematemesis. [EU]

Emetic: An agent that causes vomiting. [EU] Enamel: A very hard whitish substance which covers the dentine of the anatomical crown of a tooth. [NIH] Endocrine System: The system of glands that release their secretions (hormones) directly into the circulatory system. In addition to the endocrine glands, included are the chromaffin system and the neurosecretory systems. [NIH] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Endogenous: Produced inside an organism or cell. The opposite is external (exogenous) production. [NIH] Endometrial: Having to do with the endometrium (the layer of tissue that lines the uterus). [NIH]

Endometriosis: A condition in which tissue more or less perfectly resembling the uterine mucous membrane (the endometrium) and containing typical endometrial granular and stromal elements occurs aberrantly in various locations in the pelvic cavity. [NIH] Endometrium: The layer of tissue that lines the uterus. [NIH] Endorphin: Opioid peptides derived from beta-lipotropin. Endorphin is the most potent naturally occurring analgesic agent. It is present in pituitary, brain, and peripheral tissues. [NIH]

Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Eosinophils: Granular leukocytes with a nucleus that usually has two lobes connected by a slender thread of chromatin, and cytoplasm containing coarse, round granules that are uniform in size and stainable by eosin. [NIH] Epidemiological: Relating to, or involving epidemiology. [EU] Epidermis: Nonvascular layer of the skin. It is made up, from within outward, of five layers: 1) basal layer (stratum basale epidermidis); 2) spinous layer (stratum spinosum epidermidis); 3) granular layer (stratum granulosum epidermidis); 4) clear layer (stratum lucidum epidermidis); and 5) horny layer (stratum corneum epidermidis). [NIH] Epigastric: Having to do with the upper middle area of the abdomen. [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelial Cells: Cells that line the inner and outer surfaces of the body. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks

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containing hemoglobin whose function is to transport oxygen. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Estradiol: The most potent mammalian estrogenic hormone. It is produced in the ovary, placenta, testis, and possibly the adrenal cortex. [NIH] Estriol: (16 alpha,17 beta)-Estra-1,3,5(10)-triene-3,16,17-triol. A metabolite of estradiol and usually the predominant estrogenic metabolite in urine. During pregnancy, large amounts of estriol are produced by the placenta. It has also been obtained from plant sources. The 16 beta-isomer has also been isolated from the urine of pregnant women. [NIH] Estrogen: One of the two female sex hormones. [NIH] Estrogen Antagonists: Compounds which inhibit or antagonize the action or biosynthesis of estrogen. [NIH] Estrogen receptor: ER. Protein found on some cancer cells to which estrogen will attach. [NIH]

Estrogen Receptor Modulators: Substances that possess antiestrogenic actions but can also produce estrogenic effects as well. They act as complete or partial agonist or as antagonist. They can be either steroidal or nonsteroidal in structure. [NIH] Estrogen Replacement Therapy: The use of hormonal agents with estrogen-like activity in postmenopausal or other estrogen-deficient women to alleviate effects of hormone deficiency, such as vasomotor symptoms, dyspareunia, and progressive development of osteoporosis. This may also include the use of progestational agents in combination therapy. [NIH]

Ethinyl Estradiol: A semisynthetic estrogen with high oral estrogenic potency. It is often used as the estrogenic component in oral contraceptives. [NIH] Ethnic Groups: A group of people with a common cultural heritage that sets them apart from others in a variety of social relationships. [NIH] Evacuation: An emptying, as of the bowels. [EU] Excipients: Usually inert substances added to a prescription in order to provide suitable consistency to the dosage form; a binder, matrix, base or diluent in pills, tablets, creams, salves, etc. [NIH] 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] Exocrine: Secreting outwardly, via a duct. [EU] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Extrapyramidal: Outside of the pyramidal tracts. [EU] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]

Feasibility Studies: Studies to determine the advantages or disadvantages, practicability, or capability of accomplishing a projected plan, study, or project. [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]

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Femoral: Pertaining to the femur, or to the thigh. [EU] Femoral Neck Fractures: Fractures of the short, constricted portion of the thigh bone between the femur head and the trochanters. It excludes intertrochanteric fractures which are hip fractures. [NIH] Femur: The longest and largest bone of the skeleton, it is situated between the hip and the knee. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [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] Fibroid: A benign smooth muscle tumor, usually in the uterus or gastrointestinal tract. Also called leiomyoma. [NIH] Flatus: Gas passed through the rectum. [NIH] Flavoring Agents: Substances added to foods and medicine to improve the quality of taste. [NIH]

Fluorine: A nonmetallic, diatomic gas that is a trace element and member of the halogen family. It is used in dentistry as flouride to prevent dental caries. [NIH] Fluoxetine: The first highly specific serotonin uptake inhibitor. It is used as an antidepressant and often has a more acceptable side-effects profile than traditional antidepressants. [NIH] Flush: Transient, episodic redness of the face and neck caused by certain diseases, ingestion of certain drugs or other substances, heat, emotional factors, or physical exertion. [EU] Flushing: A transient reddening of the face that may be due to fever, certain drugs, exertion, stress, or a disease process. [NIH] Follicles: Shafts through which hair grows. [NIH] Food Additives: Substances which are of little or no nutritive value, but are used in the processing or storage of foods or animal feed, especially in the developed countries; includes antioxidants, food preservatives, food coloring agents, flavoring agents, anti-infective agents (both plain and local), vehicles, excipients and other similarly used substances. Many of the same substances are pharmaceutic aids when added to pharmaceuticals rather than to foods. [NIH]

Food Preservatives: Substances capable of inhibiting, retarding or arresting the process of fermentation, acidification or other deterioration of foods. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Free Radicals: Highly reactive molecules with an unsatisfied electron valence pair. Free radicals are produced in both normal and pathological processes. They are proven or suspected agents of tissue damage in a wide variety of circumstances including radiation, damage from environment chemicals, and aging. Natural and pharmacological prevention of free radical damage is being actively investigated. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gastric: Having to do with the stomach. [NIH]

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Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]

Gastroenteritis: An acute inflammation of the lining of the stomach and intestines, characterized by anorexia, nausea, diarrhoea, abdominal pain, and weakness, which has various causes, including food poisoning due to infection with such organisms as Escherichia coli, Staphylococcus aureus, and Salmonella species; consumption of irritating food or drink; or psychological factors such as anger, stress, and fear. Called also enterogastritis. [EU] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] 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]

Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Genistein: An isoflavonoid derived from soy products. It inhibits protein-tyrosine kinase and topoisomerase-ii (dna topoisomerase (atp-hydrolysing)) activity and is used as an antineoplastic and antitumor agent. Experimentally, it has been shown to induce G2 phase arrest in human and murine cell lines. [NIH] Genital: Pertaining to the genitalia. [EU] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Germ Cells: The reproductive cells in multicellular organisms. [NIH] Gingivitis: Inflammation of the gingivae. Gingivitis associated with bony changes is referred to as periodontitis. Called also oulitis and ulitis. [EU] Ginseng: An araliaceous genus of plants that contains a number of pharmacologically active agents used as stimulants, sedatives, and tonics, especially in traditional medicine. [NIH] 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] Glucocorticoid: A compound that belongs to the family of compounds called corticosteroids (steroids). Glucocorticoids affect metabolism and have anti-inflammatory and immunosuppressive effects. They may be naturally produced (hormones) or synthetic (drugs). [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glycine: A non-essential amino acid. It is found primarily in gelatin and silk fibroin and used therapeutically as a nutrient. It is also a fast inhibitory neurotransmitter. [NIH] Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Glycopyrrolate: A muscarinic antagonist used as an antispasmodic, in some disorders of the gastrointestinal tract, and to reduce salivation with some anesthetics. [NIH] Glycoside: Any compound that contains a carbohydrate molecule (sugar), particularly any such natural product in plants, convertible, by hydrolytic cleavage, into sugar and a nonsugar component (aglycone), and named specifically for the sugar contained, as glucoside (glucose), pentoside (pentose), fructoside (fructose) etc. [EU] Gonad: A sex organ, such as an ovary or a testicle, which produces the gametes in most

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multicellular animals. [NIH] Gonadal: Pertaining to a gonad. [EU] Gonadal Dysgenesis: Any of several developmental anomalies involving the total or partial failure of the indifferent embryonic gonad to differentiate into ovary or testis. This concept includes gonadal agenesis. [NIH] Gonadorelin: A decapeptide hormone released by the hypothalamus. It stimulates the synthesis and secretion of both follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the pituitary gland. [NIH] Gonadotropic: Stimulating the gonads; applied to hormones of the anterior pituitary which influence the gonads. [EU] Gonadotropin: The water-soluble follicle stimulating substance, by some believed to originate in chorionic tissue, obtained from the serum of pregnant mares. It is used to supplement the action of estrogens. [NIH] Goserelin: 6-(O-(1,1-Dimethylethyl)-D-serine)-10-deglycinamideluteinizing hormonereleasing factor (pig) 2-(aminocarbonyl)hydrazide. A long-acting gonadorelin agonist. It is used in the treatment of malignant neoplasms of the prostate, uterine fibromas, and metastatic breast cancer. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Granulosa Cells: Cells of the membrana granulosa lining the vesicular ovarian follicle which become luteal cells after ovulation. [NIH] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Haematemesis: The vomiting of blood. [EU] Haploid: An organism with one basic chromosome set, symbolized by n; the normal condition of gametes in diploids. [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 attack: A seizure of weak or abnormal functioning of the heart. [NIH] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH] Hematology: A subspecialty of internal medicine concerned with morphology, physiology, and pathology of the blood and blood-forming tissues. [NIH] Heme: The color-furnishing portion of hemoglobin. It is found free in tissues and as the

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prosthetic group in many hemeproteins. [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] 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]

Hepatocytes: The main structural component of the liver. They are specialized epithelial cells that are organized into interconnected plates called lobules. [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]

High-density lipoproteins: Lipoproteins that contain a small amount of cholesterol and carry cholesterol away from body cells and tissues to the liver for excretion from the body. Low-level HDL increases the risk of heart disease, so the higher the HDL level, the better. The HDL component normally contains 20 to 30 percent of total cholesterol, and HDL levels are inversely correlated with coronary heart disease risk. [NIH] Hip Fractures: Fractures of the femur head, the femur neck, the trochanters, or the inter- or subtrochanteric region. Excludes fractures of the acetabulum and fractures of the femoral shaft below the subtrochanteric region. For the fractures of the femur neck the specific term femoral neck fractures is available. [NIH] Hirsutism: Excess hair in females and children with an adult male pattern of distribution. The concept does not include hypertrichosis, which is localized or generalized excess hair. [NIH]

Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormonal therapy: Treatment of cancer by removing, blocking, or adding hormones. Also called hormone therapy or endocrine therapy. [NIH] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hormone Replacement Therapy: Therapeutic use of hormones to alleviate the effects of hormone deficiency. [NIH] Hormone therapy: Treatment of cancer by removing, blocking, or adding hormones. Also called endocrine therapy. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1

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isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrophobic: Not readily absorbing water, or being adversely affected by water, as a hydrophobic colloid. [EU] Hydroxylation: Hydroxylate, to introduce hydroxyl into (a compound or radical) usually by replacement of hydrogen. [EU] Hydroxyproline: A hydroxylated form of the imino acid proline. A deficiency in ascorbic acid can result in impaired hydroxyproline formation. [NIH] Hypercalcemia: Abnormally high level of calcium in the blood. [NIH] Hypercholesterolemia: Abnormally high levels of cholesterol in the blood. [NIH] Hyperlipidemia: An excess of lipids in the blood. [NIH] Hyperplasia: An increase in the number of cells in a tissue or organ, not due to tumor formation. It differs from hypertrophy, which is an increase in bulk without an increase in the number of cells. [NIH] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hypertrichosis: Localized or generalized excess hair. The concept does not include hirsutism, which is excess hair in females and children with an adult male pattern of distribution. [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] Hypnotic: A drug that acts to induce sleep. [EU] Hypoglycemia: Abnormally low blood sugar [NIH] Hypogonadism: Condition resulting from or characterized by abnormally decreased functional activity of the gonads, with retardation of growth and sexual development. [NIH] Hypokinesia: Slow or diminished movement of body musculature. It may be associated with basal ganglia diseases; mental disorders; prolonged inactivity due to illness; experimental protocols used to evaluate the physiologic effects of immobility; and other conditions. [NIH] Hypotension: Abnormally low blood pressure. [NIH] Hypothalamic: Of or involving the hypothalamus. [EU] Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH] Hypothermia: Lower than normal body temperature, especially in warm-blooded animals; in man usually accidental or unintentional. [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] Ileum: The lower end of the small intestine. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

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Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunization: Deliberate stimulation of the host's immune response. Active immunization involves administration of antigens or immunologic adjuvants. Passive immunization involves administration of immune sera or lymphocytes or their extracts (e.g., transfer factor, immune RNA) or transplantation of immunocompetent cell producing tissue (thymus or bone marrow). [NIH] Immunoassay: Immunochemical assay or detection of a substance by serologic or immunologic methods. Usually the substance being studied serves as antigen both in antibody production and in measurement of antibody by the test substance. [NIH] Immunocompromised: Having a weakened immune system caused by certain diseases or treatments. [NIH] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Immunology: The study of the body's immune system. [NIH] Immunosuppressive: Describes the ability to lower immune system responses. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Impotence: The inability to perform sexual intercourse. [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] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] 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]

Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Inflammation: A pathological process characterized by injury or destruction of tissues

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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] Ingestion: Taking into the body by mouth [NIH] Inhibin: Glyceroprotein hormone produced in the seminiferous tubules by the Sertoli cells in the male and by the granulosa cells in the female follicles. The hormone inhibits FSH and LH synthesis and secretion by the pituitary cells thereby affecting sexual maturation and fertility. [NIH] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH] Inotropic: Affecting the force or energy of muscular contractions. [EU] Insomnia: Difficulty in going to sleep or getting enough sleep. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Internal Medicine: A medical specialty concerned with the diagnosis and treatment of diseases of the internal organ systems of adults. [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] Intramuscular: IM. Within or into muscle. [NIH] Intravenous: IV. Into a vein. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] 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]

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] 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] Isoflavones: 3-Phenylchromones. Isomeric form of flavones in which the benzene group is attached to the 3 position of the benzopyran ring instead of the 2 position. [NIH] Isoleucine: An essential branched-chain amino acid found in many proteins. It is an isomer of LEUCINE. It is important in hemoglobin synthesis and regulation of blood sugar and energy levels. [NIH] Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH]

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Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Keratolytic: An agent that promotes keratolysis. [EU] 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] Leiomyoma: A benign tumor derived from smooth muscle tissue, also known as a fibroid tumor. They rarely occur outside of the uterus and the gastrointestinal tract but can occur in the skin and subcutaneous tissues, probably arising from the smooth muscle of small blood vessels in these tissues. [NIH] Lens: The transparent, double convex (outward curve on both sides) structure suspended between the aqueous and vitreous; helps to focus light on the retina. [NIH] Leucine: An essential branched-chain amino acid important for hemoglobin formation. [NIH] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Leuprolide: A potent and long acting analog of naturally occurring gonadotropin-releasing hormone (gonadorelin). Its action is similar to gonadorelin, which regulates the synthesis and release of pituitary gonadotropins. [NIH] Libido: The psychic drive or energy associated with sexual instinct in the broad sense (pleasure and love-object seeking). It may also connote the psychic energy associated with instincts in general that motivate behavior. [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Ligands: A RNA simulation method developed by the MIT. [NIH] Lipid: Fat. [NIH] Lipoprotein: Any of the lipid-protein complexes in which lipids are transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or cholesterol esters surrounded by an amphipathic monolayer of phospholipids, cholesterol, and apolipoproteins; the four principal classes are high-density, low-density, and very-lowdensity lipoproteins and chylomicrons. [EU] Lipoprotein(a): A family of lipoprotein particles varying in density and size depending on the protein-lipid ratio and the protein composition. These particles consist of apolipoprotein B-100 covalently linked to apolipoprotein-a by one or two disulfide bonds. There is a correlation between high plasma levels of this lipoprotein and increased risk for atherosclerotic cardiovascular disease. [NIH] 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] Locomotion: Movement or the ability to move from one place or another. It can refer to humans, vertebrate or invertebrate animals, and microorganisms. [NIH] Low-density lipoprotein: Lipoprotein that contains most of the cholesterol in the blood. LDL carries cholesterol to the tissues of the body, including the arteries. A high level of LDL

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increases the risk of heart disease. LDL typically contains 60 to 70 percent of the total serum cholesterol and both are directly correlated with CHD risk. [NIH] Luteal Phase: The period of the menstrual cycle that begins with ovulation and ends with menstruation. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]

Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphatic system: The tissues and organs that produce, store, and carry white blood cells that fight infection and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes and a network of thin tubes that carry lymph and white blood cells. These tubes branch, like blood vessels, into all the tissues of the body. [NIH] 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] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Malignancy: A cancerous tumor that can invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]

Mammary: Pertaining to the mamma, or breast. [EU] Mammography: Radiographic examination of the breast. [NIH] Manic: Affected with mania. [EU] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medical castration: Refers to the use of drugs to suppress the function of the ovaries or testicles. [NIH] Medical Staff: Professional medical personnel who provide care to patients in an organized facility, institution or agency. [NIH] Medicament: A medicinal substance or agent. [EU] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Medroxyprogesterone: (6 alpha)-17-Hydroxy-6-methylpregn-4-ene-3,20-dione. A synthetic

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progestational hormone used in veterinary practice as an estrus regulator. [NIH] Medroxyprogesterone Acetate: An injectable contraceptive, generally marketed under the name Depo-Provera. [NIH] Megestrol Acetate: A drug that belongs to the group of hormones called progestins, used as hormone therapy to block estrogen and to suppress the effects of estrogen and androgens. [NIH]

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] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU] Metastasis: The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases. [NIH] Metastatic: Having to do with metastasis, which is the spread of cancer from one part of the body to another. [NIH] Methionine: A sulfur containing essential amino acid that is important in many body functions. It is a chelating agent for heavy metals. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Micro-organism: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Milliliter: A measure of volume for a liquid. A milliliter is approximately 950-times smaller than a quart and 30-times smaller than a fluid ounce. A milliliter of liquid and a cubic centimeter (cc) of liquid are the same. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Modulator: A specific inductor that brings out characteristics peculiar to a definite region. [EU]

Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU]

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Molecular Structure: The location of the atoms, groups or ions relative to one another in a molecule, as well as the number, type and location of covalent bonds. [NIH] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] 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] Mucins: A secretion containing mucopolysaccharides and protein that is the chief constituent of mucus. [NIH] Musculature: The muscular apparatus of the body, or of any part of it. [EU] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Naloxone: A specific opiate antagonist that has no agonist activity. It is a competitive antagonist at mu, delta, and kappa opioid receptors. [NIH] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Neoplasms: New abnormal growth of tissue. Malignant neoplasms show a greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign neoplasms. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Nervousness: Excessive excitability and irritability, with mental and physical unrest. [EU] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH]

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Neuropeptide: A member of a class of protein-like molecules made in the brain. Neuropeptides consist of short chains of amino acids, with some functioning as neurotransmitters and some functioning as hormones. [NIH] Neurotensin: A biologically active tridecapeptide isolated from the hypothalamus. It has been shown to induce hypotension in the rat, to stimulate contraction of guinea pig ileum and rat uterus, and to cause relaxation of rat duodenum. There is also evidence that it acts as both a peripheral and a central nervous system neurotransmitter. [NIH] Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light hydrogen; the mass is equal to that of the proton and electron combined and they are unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH] Neutrophils: Granular leukocytes having a nucleus with three to five lobes connected by slender threads of chromatin, and cytoplasm containing fine inconspicuous granules and stainable by neutral dyes. [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] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Norethindrone: A synthetic progestational hormone with actions similar to those of progesterone but functioning as a more potent inhibitor of ovulation. It has weak estrogenic and androgenic properties. The hormone has been used in treating amenorrhea, functional uterine bleeding, endometriosis, and for contraception. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nutritive Value: An indication of the contribution of a food to the nutrient content of the diet. This value depends on the quantity of a food which is digested and absorbed and the amounts of the essential nutrients (protein, fat, carbohydrate, minerals, vitamins) which it contains. This value can be affected by soil and growing conditions, handling and storage, and processing. [NIH] Oocytes: Female germ cells in stages between the prophase of the first maturation division and the completion of the second maturation division. [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] Optic Chiasm: The X-shaped structure formed by the meeting of the two optic nerves. At the optic chiasm the fibers from the medial part of each retina cross to project to the other

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side of the brain while the lateral retinal fibers continue on the same side. As a result each half of the brain receives information about the contralateral visual field from both eyes. [NIH]

Oral Health: The optimal state of the mouth and normal functioning of the organs of the mouth without evidence of disease. [NIH] Orchiectomy: The surgical removal of one or both testicles. [NIH] Osteoclasts: A large multinuclear cell associated with the absorption and removal of bone. An odontoclast, also called cementoclast, is cytomorphologically the same as an osteoclast and is involved in cementum resorption. [NIH] Osteoporosis: Reduction of bone mass without alteration in the composition of bone, leading to fractures. Primary osteoporosis can be of two major types: postmenopausal osteoporosis and age-related (or senile) osteoporosis. [NIH] Ovariectomy: The surgical removal of one or both ovaries. [NIH] Ovaries: The pair of female reproductive glands in which the ova, or eggs, are formed. The ovaries are located in the pelvis, one on each side of the uterus. [NIH] Ovary: Either of the paired glands in the female that produce the female germ cells and secrete some of the female sex hormones. [NIH] Ovulation: The discharge of a secondary oocyte from a ruptured graafian follicle. [NIH] Ovum: A female germ cell extruded from the ovary at ovulation. [NIH] 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]

Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Panic: A state of extreme acute, intense anxiety and unreasoning fear accompanied by disorganization of personality function. [NIH] Parathyroid: 1. Situated beside the thyroid gland. 2. One of the parathyroid glands. 3. A sterile preparation of the water-soluble principle(s) of the parathyroid glands, ad-ministered parenterally as an antihypocalcaemic, especially in the treatment of acute hypoparathyroidism with tetany. [EU] Parathyroid Glands: Two small paired endocrine glands in the region of the thyroid gland. They secrete parathyroid hormone and are concerned with the metabolism of calcium and phosphorus. [NIH] Parathyroid hormone: A substance made by the parathyroid gland that helps the body store and use calcium. Also called parathormone, parathyrin, or PTH. [NIH] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Paroxetine: A serotonin uptake inhibitor that is effective in the treatment of depression. [NIH]

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Paroxetine hydrochloride: An antidepressant drug. [NIH] 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] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Pelvic: Pertaining to the pelvis. [EU] Pelvis: The lower part of the abdomen, located between the hip bones. [NIH] Penicillin: An antibiotic drug used to treat infection. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Perimenopausal: The time of a woman's life when menstrual periods become irregular. Refers to the time near menopause. [NIH] Periodontal disease: Disease involving the supporting structures of the teeth (as the gums and periodontal membranes). [NIH] Periodontal disease: Disease involving the supporting structures of the teeth (as the gums and periodontal membranes). [NIH] Periodontitis: Inflammation of the periodontal membrane; also called periodontitis simplex. [NIH]

Peripheral blood: Blood circulating throughout the body. [NIH] Perivascular: Situated around a vessel. [EU] 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] Pharmaceutic Aids: Substances which are of little or no therapeutic value, but are necessary in the manufacture, compounding, storage, etc., of pharmaceutical preparations or drug dosage forms. They include solvents, diluting agents, and suspending agents, and emulsifying agents. Also, antioxidants; preservatives, pharmaceutical; dyes (coloring agents); flavoring agents; vehicles; excipients; ointment bases. [NIH] Pharmaceutical Preparations: Drugs intended for human or veterinary use, presented in their finished dosage form. Included here are materials used in the preparation and/or formulation of the finished dosage form. [NIH] Pharmacogenetics: A branch of genetics which deals with the genetic components of variability in individual responses to and metabolism (biotransformation) of drugs. [NIH] Pharmacokinetic: The mathematical analysis of the time courses of absorption, distribution, and elimination of drugs. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phenyl: Ingredient used in cold and flu remedies. [NIH]

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Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Photocoagulation: Using a special strong beam of light (laser) to seal off bleeding blood vessels such as in the eye. The laser can also burn away blood vessels that should not have grown in the eye. This is the main treatment for diabetic retinopathy. [NIH] 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] Pilot study: The initial study examining a new method or treatment. [NIH] Pineal Body: A small conical midline body attached to the posterior part of the third ventricle and lying between the superior colliculi, below the splenium of the corpus callosum. [NIH] Pineal gland: A tiny organ located in the cerebrum that produces melatonin. Also called pineal body or pineal organ. [NIH] Placenta: A highly vascular fetal organ through which the fetus absorbs oxygen and other nutrients and excretes carbon dioxide and other wastes. It begins to form about the eighth day of gestation when the blastocyst adheres to the decidua. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] 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] Polymorphic: Occurring in several or many forms; appearing in different forms at different stages of development. [EU] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postmenopausal: Refers to the time after menopause. Menopause is the time in a woman's life when menstrual periods stop permanently; also called "change of life." [NIH] Postmenopause: The physiological period following the menopause, the permanent cessation of the menstrual life. Since in the United States the age of the menopause ranges between 48 and 55 years, generally conceived as middle age, the postmenopause often refers to women considerably older. [NIH] Practicability: A non-standard characteristic of an analytical procedure. It is dependent on

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the scope of the method and is determined by requirements such as sample throughout and costs. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Preclinical: Before a disease becomes clinically recognizable. [EU] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Premenopausal: Refers to the time before menopause. Menopause is the time of life when a women's menstrual periods stop permanently; also called "change of life." [NIH] Premenstrual: Occurring before menstruation. [EU] Premenstrual Syndrome: A syndrome occurring most often during the last week of the menstrual cycle and ending soon after the onset of menses. Some of the symptoms are emotional instability, insomnia, headache, nausea, vomiting, abdominal distension, and painful breasts. [NIH] 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 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] 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] 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] Promoter: A chemical substance that increases the activity of a carcinogenic process. [NIH] Prophase: The first phase of cell division, in which the chromosomes become visible, the nucleus starts to lose its identity, the spindle appears, and the centrioles migrate toward opposite poles. [NIH] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests

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upon the rectum. [NIH] Prostatic Hyperplasia: Enlargement or overgrowth of the prostate gland as a result of an increase in the number of its constituent cells. [NIH] 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] Protein-Tyrosine Kinase: An enzyme that catalyzes the phosphorylation of tyrosine residues in proteins with ATP or other nucleotides as phosphate donors. EC 2.7.1.112. [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] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psyllium: Dried, ripe seeds of Plantago psyllium, P. indica, and P. ovata (Plantaginaceae). Plantain seeds swell in water and are used as demulcents and bulk laxatives. [NIH] Puberty: The period during which the secondary sex characteristics begin to develop and the capability of sexual reproduction is attained. [EU] Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulmonary Edema: An accumulation of an excessive amount of watery fluid in the lungs, may be caused by acute exposure to dangerous concentrations of irritant gasses. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]

Quality of Life: A generic concept reflecting concern with the modification and

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enhancement of life attributes, e.g., physical, political, moral and social environment. [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] Raloxifene: A second generation selective estrogen receptor modulator (SERM) used to prevent osteoporosis in postmenopausal women. It has estrogen agonist effects on bone and cholesterol metabolism but behaves as a complete estrogen antagonist on mammary gland and uterine tissue. [NIH] Random Allocation: A process involving chance used in therapeutic trials or other research endeavor for allocating experimental subjects, human or animal, between treatment and control groups, or among treatment groups. It may also apply to experiments on inanimate objects. [NIH] Randomization: Also called random allocation. Is allocation of individuals to groups, e.g., for experimental and control regimens, by chance. Within the limits of chance variation, random allocation should make the control and experimental groups similar at the start of an investigation and ensure that personal judgment and prejudices of the investigator do not influence allocation. [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] Reagent: A substance employed to produce a chemical reaction so as to detect, measure, produce, etc., other substances. [EU] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Receptors, Serotonin: Cell-surface proteins that bind serotonin and trigger intracellular changes which influence the behavior of cells. Several types of serotonin receptors have been recognized which differ in their pharmacology, molecular biology, and mode of action. [NIH] 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] Red blood cells: RBCs. Cells that carry oxygen to all parts of the body. Also called erythrocytes. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Resorption: The loss of substance through physiologic or pathologic means, such as loss of dentin and cementum of a tooth, or of the alveolar process of the mandible or maxilla. [EU] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration

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(= cell respiration). [NIH] Response rate: The percentage of patients whose cancer shrinks or disappears after treatment. [NIH] Rheumatism: A group of disorders marked by inflammation or pain in the connective tissue structures of the body. These structures include bone, cartilage, and fat. [NIH] Rheumatoid: Resembling rheumatism. [EU] Rheumatoid arthritis: A form of arthritis, the cause of which is unknown, although infection, hypersensitivity, hormone imbalance and psychologic stress have been suggested as possible causes. [NIH] Rigidity: Stiffness or inflexibility, chiefly that which is abnormal or morbid; rigor. [EU] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Saliva: The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptylin. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Salivation: 1. The secretion of saliva. 2. Ptyalism (= excessive flow of saliva). [EU] Sapogenins: The aglucon moiety of a saponin molecule. It may be triterpenoid or steroid, usually spirostan, in nature. [NIH] Saponin: A substance found in soybeans and many other plants. Saponins may help lower cholesterol and may have anticancer effects. [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] 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] Selective estrogen receptor modulator: SERM. A drug that acts like estrogen on some tissues, but blocks the effect of estrogen on other tissues. Tamoxifen and raloxifene are SERMs. [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Seminiferous tubule: Tube used to transport sperm made in the testes. [NIH] Semisynthetic: Produced by chemical manipulation of naturally occurring substances. [EU] Senile: Relating or belonging to old age; characteristic of old age; resulting from infirmity of old age. [NIH] Senna: Preparations of Cassia senna L. and C. angustifolia of the Leguminosae. They contain sennosides, which are anthraquinone type cathartics and are used in many different preparations as laxatives. [NIH] Serine: A non-essential amino acid occurring in natural form as the L-isomer. It is

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synthesized from glycine or threonine. It is involved in the biosynthesis of purines, pyrimidines, and other amino acids. [NIH] Serologic: Analysis of a person's serum, especially specific immune or lytic serums. [NIH] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] 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] 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] 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] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Smooth Muscle Tumor: A tumor composed of smooth muscle tissue, as opposed to leiomyoma, a tumor derived from smooth muscle. [NIH] Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Solid tumor: Cancer of body tissues other than blood, bone marrow, or the lymphatic system. [NIH] Soma: The body as distinct from the mind; all the body tissue except the germ cells; all the axial body. [NIH]

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Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Spatial disorientation: Loss of orientation in space where person does not know which way is up. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sperm: The fecundating fluid of the male. [NIH] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Sterile: Unable to produce children. [NIH] Sterility: 1. The inability to produce offspring, i.e., the inability to conceive (female s.) or to induce conception (male s.). 2. The state of being aseptic, or free from microorganisms. [EU] Sternum: Breast bone. [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] Stimulant: 1. Producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. An agent or remedy that produces stimulation. [EU]

Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Strand: DNA normally exists in the bacterial nucleus in a helix, in which two strands are coiled together. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Stromal: Large, veil-like cell in the bone marrow. [NIH] Subarachnoid: Situated or occurring between the arachnoid and the pia mater. [EU]

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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]

Subtrochanteric: Below a trochanter. [NIH] Sulfur: An element that is a member of the chalcogen family. It has an atomic symbol S, atomic number 16, and atomic weight 32.066. It is found in the amino acids cysteine and methionine. [NIH] Supplementation: Adding nutrients to the diet. [NIH] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Suprachiasmatic Nucleus: An ovoid densely packed collection of small cells of the anterior hypothalamus lying close to the midline in a shallow impression of the optic chiasm. [NIH] 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] Sweat: The fluid excreted by the sweat glands. It consists of water containing sodium chloride, phosphate, urea, ammonia, and other waste products. [NIH] Sympathomimetic: 1. Mimicking the effects of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. 2. An agent that produces effects similar to those of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. Called also adrenergic. [EU] Symphysis: A secondary cartilaginous joint. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Systemic: Affecting the entire body. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Tamoxifen: A first generation selective estrogen receptor modulator (SERM). It acts as an agonist for bone tissue and cholesterol metabolism but is an estrogen antagonist in mammary and uterine. [NIH] Testicles: The two egg-shaped glands found inside the scrotum. They produce sperm and male hormones. Also called testes. [NIH] Testicular: Pertaining to a testis. [EU] Testis: Either of the paired male reproductive glands that produce the male germ cells and the male hormones. [NIH] Tetany: 1. Hyperexcitability of nerves and muscles due to decrease in concentration of extracellular ionized calcium, which may be associated with such conditions as parathyroid

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hypofunction, vitamin D deficiency, and alkalosis or result from ingestion of alkaline salts; it is characterized by carpopedal spasm, muscular twitching and cramps, laryngospasm with inspiratory stridor, hyperreflexia and choreiform movements. 2. Tetanus. [EU] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thermoregulation: Heat regulation. [EU] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin. (Dorland, 27th ed) EC 3.4.21.5. [NIH] Thrombomodulin: A cell surface glycoprotein of endothelial cells that binds thrombin and serves as a cofactor in the activation of protein C and its regulation of blood coagulation. [NIH]

Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Thyroid Gland: A highly vascular endocrine gland consisting of two lobes, one on either side of the trachea, joined by a narrow isthmus; it produces the thyroid hormones which are concerned in regulating the metabolic rate of the body. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tomography: Imaging methods that result in sharp images of objects located on a chosen plane and blurred images located above or below the plane. [NIH] Topical: On the surface of the body. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicokinetics: Study of the absorption, distribution, metabolism, and excretion of test substances. [NIH] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Trace element: Substance or element essential to plant or animal life, but present in extremely small amounts. [NIH] Transdermal: Entering through the dermis, or skin, as in administration of a drug applied to the skin in ointment or patch form. [EU] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Translating: Conversion from one language to another language. [NIH] Translation: The process whereby the genetic information present in the linear sequence of

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ribonucleotides in mRNA is converted into a corresponding sequence of amino acids in a protein. It occurs on the ribosome and is unidirectional. [NIH] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH] Tricyclic: Containing three fused rings or closed chains in the molecular structure. [EU] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tumor marker: A substance sometimes found in an increased amount in the blood, other body fluids, or tissues and which may mean that a certain type of cancer is in the body. Examples of tumor markers include CA 125 (ovarian cancer), CA 15-3 (breast cancer), CEA (ovarian, lung, breast, pancreas, and gastrointestinal tract cancers), and PSA (prostate cancer). Also called biomarker. [NIH] 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] Ureters: Tubes that carry urine from the kidneys to the bladder. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary tract: The organs of the body that produce and discharge urine. These include the kidneys, ureters, bladder, and urethra. [NIH] Urinary tract infection: An illness caused by harmful bacteria growing in the urinary tract. [NIH]

Urinate: To release urine from the bladder to the outside. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] 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] Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Vaginal: Of or having to do with the vagina, the birth canal. [NIH] Valine: A branched-chain essential amino acid that has stimulant activity. It promotes muscle growth and tissue repair. It is a precursor in the penicillin biosynthetic pathway. [NIH]

Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasodilator: An agent that widens blood vessels. [NIH] Vasomotor: 1. Affecting the calibre of a vessel, especially of a blood vessel. 2. Any element or agent that effects the calibre of a blood vessel. [EU] VE: The total volume of gas either inspired or expired in one minute. [NIH] Venlafaxine: An antidepressant drug that is being evaluated for the treatment of hot flashes in women who have breast cancer. [NIH]

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Venous: Of or pertaining to the veins. [EU] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Vertebrae: A bony unit of the segmented spinal column. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] 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] 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] Void: To urinate, empty the bladder. [NIH] Voltage-gated: It is opened by the altered charge distribution across the cell membrane. [NIH]

Weight Gain: Increase in body weight over existing weight. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]

Womb: A hollow, thick-walled, muscular organ in which the impregnated ovum is developed into a child. [NIH] Xenograft: The cells of one species transplanted to another species. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH] Yeasts: A general term for single-celled rounded fungi that reproduce by budding. Brewers' and bakers' yeasts are Saccharomyces cerevisiae; therapeutic dried yeast is dried yeast. [NIH] Zymogen: Inactive form of an enzyme which can then be converted to the active form, usually by excision of a polypeptide, e. g. trypsinogen is the zymogen of trypsin. [NIH]

163

INDEX 5 5-Hydroxytryptophan, 53, 123 A Abdominal, 81, 123, 139, 150, 153 Aberrant, 74, 123 Ablation, 33, 34, 123 Acceptor, 123, 150 Acne, 77, 123, 133 Adjuvant, 18, 64, 65, 123 Adrenal Cortex, 123, 137, 153 Adrenal Medulla, 123, 129, 136, 149 Adrenergic, 123, 135, 136, 159 Adverse Effect, 6, 7, 11, 18, 123, 157 Aerobic, 93, 123 Aerobic Exercise, 93, 123 Aetiology, 28, 123 Affinity, 8, 123, 124 Agenesis, 123, 140 Agonist, 11, 29, 48, 70, 124, 135, 137, 140, 148, 155, 159 Airway, 124, 157 Alfalfa, 69, 124 Algorithms, 124, 127 Alimentary, 124, 150 Alkaline, 124, 129, 131, 160 Alpha Particles, 124, 155 Alternative medicine, 8, 9, 46, 92, 124 Ameliorated, 27, 74, 124 Ameliorating, 36, 75, 124 Amenorrhea, 52, 124, 149 Amino acid, 8, 73, 78, 124, 128, 139, 144, 145, 147, 149, 151, 154, 156, 157, 159, 161 Amoxicillin, 62, 124 Ampicillin, 124 Anal, 16, 124 Analgesic, 124, 136 Analog, 12, 69, 124, 145 Analytes, 108, 124 Anatomical, 124, 130, 136, 143 Androgenic, 80, 124, 134, 149 Androgens, 81, 96, 123, 124, 147 Anemia, 125 Anesthetics, 125, 136, 139 Animal model, 15, 19, 125 Anomalies, 125, 140 Anorexia, 9, 125, 139 Anthraquinones, 125, 129 Antibacterial, 125, 158

Antibiotic, 63, 124, 125, 128, 151, 158 Antibody, 123, 125, 131, 140, 143, 146, 158 Anticoagulant, 125, 154 Anticonvulsant, 8, 125 Antidepressant, 20, 49, 90, 91, 123, 125, 138, 151, 161 Antiepileptic, 123, 125 Antigen, 123, 125, 132, 142, 143, 146 Anti-infective, 125, 138 Anti-Infective Agents, 125, 138 Anti-inflammatory, 125, 139 Antimicrobial, 62, 125, 130 Antineoplastic, 125, 139 Antioxidant, 10, 126 Antispasmodic, 126, 139 Anus, 124, 126, 128 Anxiety, 13, 63, 74, 75, 78, 84, 126, 150 Aplastic anemia, 59, 126 Apnea, 126 Apolipoproteins, 126, 145 Aqueous, 126, 145 Arterial, 25, 126, 130, 142, 154, 159 Arteries, 126, 127, 128, 133, 145, 147 Artery, 4, 19, 126, 133, 154 Aspirate, 60, 126 Assay, 12, 126, 131, 143 ATP, 126, 135, 139, 152, 154 Atrophy, 8, 126 Autonomic, 126, 149 Axillary, 74, 126 B Bacteria, 125, 126, 134, 137, 147, 158, 161 Basal Ganglia, 126, 142 Basal Ganglia Diseases, 126, 142 Base, 5, 9, 15, 17, 126, 134, 137, 145 Basophils, 126, 145 Benign, 81, 127, 134, 138, 140, 145, 148 Benign prostatic hyperplasia, 81, 127 Benzene, 127, 144 Bilateral, 70, 127 Bile, 127, 138, 145, 158 Biochemical, 23, 127, 157 Biomarkers, 10, 127 Biotechnology, 22, 85, 92, 103, 127 Biotransformation, 127, 151 Bipolar Disorder, 13, 127 Bladder, 5, 109, 127, 132, 143, 153, 161, 162 Blister, 21, 127

164 Hot Flashes

Blister pack, 21, 127 Blood Coagulation, 127, 129, 160 Blood Glucose, 4, 5, 7, 31, 127, 141, 144 Blood Platelets, 127, 157 Blood pressure, 5, 19, 127, 129, 142, 148 Blood vessel, 127, 128, 129, 130, 144, 145, 146, 152, 157, 158, 160, 161 Body Fluids, 127, 128, 161 Body Image, 83, 128 Bone Density, 68, 77, 128 Bone Marrow, 63, 126, 127, 128, 143, 146, 148, 157, 158 Bone metastases, 77, 128 Bone Resorption, 19, 77, 128, 129 Bowel, 78, 124, 128, 134, 144, 158 Bowel Movement, 128, 134, 158 Branch, 119, 128, 146, 151, 154, 158, 160 Breakdown, 77, 128, 134, 138 Broad-spectrum, 124, 128 Bromine, 78, 128 Burns, 93, 128 Burns, Electric, 128 C Calcifediol, 128, 129 Calcitonin, 7, 20, 31, 72, 128 Calcitonin Gene-Related Peptide, 7, 31, 72, 128 Calcitriol, 20, 128 Calcium, 8, 70, 128, 129, 131, 142, 150, 159 Calcium Channels, 8, 129 Carcinogenesis, 9, 20, 129 Carcinogenic, 127, 129, 144, 153, 158 Carcinoma, 27, 31, 34, 46, 62, 63, 129, 133 Cardiac, 17, 18, 129, 136, 137, 148, 158 Cardiorespiratory, 123, 129 Cardiovascular, 3, 5, 8, 16, 19, 31, 68, 76, 77, 81, 129, 145, 157 Cardiovascular disease, 3, 5, 19, 68, 76, 77, 81, 129, 145 Cassia, 75, 129, 156 Castration, 31, 60, 71, 129 Cataracts, 68, 76, 129 Catecholamine, 31, 129, 135 Cell Division, 126, 129, 152, 153 Cell membrane, 129, 152, 162 Cell proliferation, 77, 129 Cellulose, 129, 152 Central Nervous System, 8, 68, 77, 80, 127, 129, 130, 140, 149, 157 Central Nervous System Infections, 130, 140 Cerebellum, 130, 133

Cerebral, 77, 78, 126, 130, 133, 136 Cerebrovascular, 126, 129, 130 Cerebrum, 130, 133, 152 Character, 130, 134 Chemoprevention, 9, 130 Chemotherapy, 21, 23, 59, 63, 64, 65, 130 Chin, 130, 147 Chlorine, 78, 130 Cholesterol, 7, 11, 19, 77, 111, 127, 130, 133, 141, 142, 145, 155, 156, 158, 159 Cholesterol Esters, 130, 145 Chronic, 4, 16, 17, 60, 130, 143, 157 Chylomicrons, 130, 145 Ciprofloxacin, 62, 130 Circadian, 16, 24, 130 Circadian Rhythm, 16, 24, 130 Climacteric, 12, 130 Clinical Medicine, 131, 153 Clinical study, 131, 132 Clinical trial, 5, 9, 10, 18, 59, 62, 63, 65, 71, 103, 131, 132, 135, 154, 155 Cloning, 127, 131 Coagulation, 7, 127, 131, 141 Cofactor, 131, 154, 160 Cognition, 9, 131 Collagen, 124, 131 Collapse, 128, 131, 157 Combination Therapy, 80, 131, 137 Comet Assay, 10, 131 Complement, 131, 132 Complementary and alternative medicine, 45, 56, 132 Complementary medicine, 45, 132 Compliance, 6, 21, 132 Computational Biology, 103, 132 Confounding, 21, 132 Conjugated, 10, 19, 96, 132, 134 Connective Tissue, 128, 131, 132, 134, 146, 156 Constipation, 17, 132 Consumption, 13, 91, 132, 134, 139, 155 Contraception, 132, 149 Contraindications, ii, 14, 132 Control group, 6, 132, 155 Controlled clinical trial, 40, 50, 132 Convulsions, 125, 133 Coronary, 19, 129, 133, 141, 147 Coronary heart disease, 129, 133, 141 Coronary Thrombosis, 133, 147 Corpus, 133, 152, 153 Corpus Luteum, 133, 153 Cortex, 133

Index 165

Cortical, 133, 156 Cortices, 77, 133 Corticosteroids, 77, 133, 139 Cranial, 78, 130, 133, 140 Craniocerebral Trauma, 126, 133, 140 Creatinine, 20, 133 Curative, 133, 160 Cyclic, 72, 78, 133 Cyproterone, 25, 60, 71, 133 Cyproterone Acetate, 60, 71, 133 Cyst, 126, 133 Cytochrome, 15, 18, 133 D Danazol, 27, 134 Data Collection, 12, 134 Degenerative, 77, 134 Dehydroepiandrosterone, 74, 134 Density, 7, 12, 128, 134, 145, 149 Dental Caries, 4, 134, 138 Dental implant, 4, 134 Dentists, 4, 134 Deprivation, 3, 6, 70, 71, 134 Dermis, 134, 160 Deuterium, 134, 142 Developed Countries, 134, 138 Diagnostic procedure, 67, 92, 134 Diaphoresis, 70, 73, 79, 134 Diastolic, 134, 142 Digestion, 124, 127, 128, 134, 144, 145, 158 Digestive system, 66, 134 Dihydrotestosterone, 133, 134 Diploid, 135, 152 Direct, iii, 8, 73, 95, 131, 135, 155 Dissociation, 123, 135 Distal, 14, 135, 154 Dizziness, 8, 70, 73, 79, 135 DNA Topoisomerase, 135, 139 Domesticated, 19, 135 Dopamine, 21, 135, 149 Double-blind, 10, 21, 135 Double-blinded, 10, 135 Drug Interactions, 97, 135 Duodenum, 127, 135, 149, 158 Dysmenorrhea, 52, 77, 135 Dyspareunia, 10, 135, 137 E Efficacy, 7, 8, 10, 13, 18, 22, 48, 59, 60, 62, 90, 135 Electrocoagulation, 131, 135 Electrophoresis, 131, 136 Emesis, 70, 136 Emetic, 70, 136

Enamel, 134, 136 Endocrine System, 136 Endocrinology, 13, 24, 26, 27, 29, 32, 35, 36, 136 Endogenous, 6, 128, 135, 136 Endometrial, 5, 10, 11, 60, 80, 136 Endometriosis, 68, 76, 77, 134, 136, 149 Endometrium, 45, 68, 77, 136, 147 Endorphin, 6, 136 Environmental Health, 102, 104, 136 Enzymatic, 124, 129, 132, 134, 136 Enzyme, 20, 135, 136, 154, 160, 162 Eosinophils, 136, 145 Epidemiological, 10, 72, 136 Epidermis, 127, 134, 136 Epigastric, 136, 150 Epinephrine, 123, 135, 136, 149, 161 Epithelial, 72, 136, 141 Epithelial Cells, 72, 136, 141 Erythrocytes, 125, 128, 136, 155 Esophagus, 134, 137, 158 Estradiol, 9, 11, 14, 36, 45, 60, 79, 96, 137 Estriol, 80, 137 Estrogen Antagonists, 68, 76, 137 Estrogen receptor, 68, 76, 77, 80, 137 Estrogen Receptor Modulators, 77, 137 Estrogen Replacement Therapy, 9, 19, 137 Ethinyl Estradiol, 20, 137 Ethnic Groups, 12, 137 Evacuation, 132, 137 Excipients, 137, 138, 151 Excitability, 137, 148 Exocrine, 137, 150 Exogenous, 14, 81, 127, 136, 137 Extrapyramidal, 135, 137 F Family Planning, 103, 137 Fat, 32, 93, 128, 133, 137, 145, 149, 156, 157 Fatigue, 6, 9, 15, 17, 21, 71, 84, 137, 140 Feasibility Studies, 17, 137 Feces, 132, 137, 158 Femoral, 138, 141 Femoral Neck Fractures, 138, 141 Femur, 138, 141 Fetus, 138, 152, 161 Fibrinogen, 7, 138, 160 Fibroid, 77, 138, 145 Flatus, 138 Flavoring Agents, 138, 151 Fluorine, 78, 138 Fluoxetine, 21, 32, 91, 138 Flush, 72, 138

166 Hot Flashes

Flushing, 4, 70, 72, 73, 74, 75, 79, 138 Follicles, 72, 134, 138, 144 Food Additives, 69, 138 Food Preservatives, 138 Forearm, 127, 138 Free Radicals, 126, 135, 138 G Gallbladder, 123, 134, 138 Gas, 25, 130, 138, 141, 149, 161 Gastric, 124, 138 Gastrin, 139, 141 Gastroenteritis, 128, 139 Gastrointestinal, 78, 130, 136, 138, 139, 145, 157, 159, 161 Gastrointestinal tract, 138, 139, 145, 157, 161 Gene, 18, 50, 85, 127, 128, 139 Genetics, 18, 139, 151 Genistein, 13, 139 Genital, 130, 139 Genotype, 18, 139, 151 Germ Cells, 139, 149, 150, 157, 159 Gingivitis, 4, 139 Ginseng, 75, 139 Gland, 123, 139, 140, 146, 150, 153, 154, 155, 156, 158, 160 Glucocorticoid, 77, 139 Glucose, 4, 7, 127, 129, 139, 141, 144 Glycine, 124, 139, 149, 157 Glycoprotein, 138, 139, 160 Glycopyrrolate, 69, 139 Glycoside, 139 Gonad, 139, 140 Gonadal, 77, 140, 158 Gonadal Dysgenesis, 77, 140 Gonadorelin, 140, 145 Gonadotropic, 10, 140 Gonadotropin, 27, 35, 79, 80, 140, 145 Goserelin, 36, 42, 64, 65, 96, 140 Governing Board, 140, 153 Granulosa Cells, 140, 144 Growth, 68, 77, 125, 129, 140, 142, 146, 148, 152, 159, 160, 161 H Haematemesis, 136, 140 Haploid, 140, 152 Haptens, 123, 140 Headache, 14, 140, 153 Headache Disorders, 140 Health Status, 12, 140 Heart attack, 23, 129, 140 Heart failure, 17, 140

Hematology, 60, 140 Heme, 133, 140 Hemoglobin, 125, 137, 140, 141, 144, 145 Hemorrhage, 133, 135, 140, 141, 158 Hemostasis, 141, 157 Hepatocytes, 18, 141 Heredity, 139, 141 Heterogeneity, 123, 141 High-density lipoproteins, 11, 141 Hip Fractures, 77, 138, 141 Hirsutism, 77, 133, 141, 142 Hormonal, 11, 14, 16, 20, 50, 68, 70, 73, 76, 79, 126, 137, 141 Hormonal therapy, 20, 50, 141 Hormone Replacement Therapy, 4, 5, 8, 10, 12, 14, 20, 23, 30, 40, 63, 64, 93, 108, 109, 141 Hormone therapy, 46, 90, 141, 147 Hydrogen, 78, 123, 126, 134, 141, 142, 148, 149, 150, 151, 154 Hydrophobic, 142, 145 Hydroxylation, 129, 142 Hydroxyproline, 124, 131, 142 Hypercalcemia, 77, 142 Hypercholesterolemia, 68, 76, 80, 81, 142 Hyperlipidemia, 80, 81, 142 Hyperplasia, 10, 142 Hypersensitivity, 142, 156 Hypertension, 80, 81, 129, 140, 142 Hypertrichosis, 141, 142 Hypertrophy, 68, 76, 127, 142 Hypnotic, 16, 142 Hypoglycemia, 4, 142 Hypogonadism, 27, 142 Hypokinesia, 78, 142 Hypotension, 133, 142, 149 Hypothalamic, 16, 26, 70, 79, 142 Hypothalamus, 140, 142, 149, 159 Hypothermia, 26, 142 Hysterectomy, 29, 41, 77, 142 I Id, 42, 52, 108, 109, 110, 111, 118, 120, 142 Ileum, 142, 149 Immune response, 123, 125, 140, 142, 143, 159 Immune system, 63, 142, 143, 161, 162 Immunization, 143, 153 Immunoassay, 20, 143 Immunocompromised, 59, 143 Immunologic, 143 Immunology, 123, 143 Immunosuppressive, 139, 143

Index 167

Impairment, 16, 77, 143, 147 Impotence, 71, 143 In situ, 63, 143 In vitro, 9, 18, 143 In vivo, 10, 18, 143 Incision, 143, 144 Incontinence, 68, 76, 77, 84, 143 Indicative, 84, 143, 151, 161 Induction, 29, 125, 143 Infarction, 133, 143, 147 Infection, 59, 62, 125, 139, 143, 146, 151, 156, 159, 162 Infertility, 64, 143 Inflammation, 4, 78, 123, 125, 139, 143, 151, 152, 156 Ingestion, 138, 144, 152, 160 Inhibin, 11, 144 Initiation, 20, 144 Inotropic, 135, 144 Insomnia, 6, 10, 16, 53, 81, 144, 153 Insulin, 4, 7, 80, 81, 144 Insulin-dependent diabetes mellitus, 144 Internal Medicine, 27, 32, 34, 136, 140, 144 Intestinal, 129, 144 Intestine, 128, 144, 145 Intramuscular, 29, 144, 150 Intravenous, 144, 150 Intrinsic, 123, 144 Invasive, 20, 144 Ion Channels, 18, 144 Ions, 126, 129, 135, 141, 144, 148 Ischemia, 126, 144 Isoflavones, 19, 55, 69, 144 Isoleucine, 73, 144 J Joint, 10, 14, 130, 144, 159 K Kb, 102, 145 Keratolytic, 134, 145 Kinetic, 145 L Large Intestine, 134, 144, 145, 155, 157 Leiomyoma, 138, 145, 157 Lens, 129, 145 Leucine, 73, 145 Leukocytes, 10, 126, 128, 136, 145, 148, 149 Leuprolide, 36, 42, 96, 145 Libido, 125, 145 Library Services, 118, 145 Ligament, 145, 153 Ligands, 68, 77, 145 Lipid, 11, 126, 144, 145

Lipoprotein, 11, 145 Lipoprotein(a), 11, 145 Liver, 12, 18, 123, 127, 128, 134, 137, 138, 141, 145 Localized, 134, 141, 142, 143, 145, 152 Locomotion, 145, 152 Low-density lipoprotein, 11, 145 Luteal Phase, 12, 20, 74, 146 Lymph, 126, 146 Lymph node, 126, 146 Lymphatic, 143, 146, 157 Lymphatic system, 146, 157 Lymphocytes, 125, 143, 145, 146, 162 Lymphoid, 62, 133, 146 M Malignancy, 77, 146 Malignant, 126, 140, 146, 148 Malnutrition, 126, 146 Mammary, 19, 20, 146, 155, 159 Mammography, 60, 146 Manic, 127, 146 Mediate, 7, 18, 135, 146 Mediator, 146, 157 Medical castration, 35, 41, 146 Medical Staff, 135, 146 Medicament, 72, 146 MEDLINE, 103, 146 Medroxyprogesterone, 10, 29, 61, 96, 146, 147 Medroxyprogesterone Acetate, 10, 147 Megestrol Acetate, 30, 33, 147 Membrane, 129, 132, 136, 137, 144, 147, 151, 152 Memory, 4, 16, 68, 76, 125, 147 Meninges, 130, 133, 147 Menstrual Cycle, 4, 12, 19, 74, 146, 147, 153 Menstruation, 69, 80, 83, 108, 124, 135, 146, 147, 153 Mental, iv, 5, 66, 71, 102, 104, 130, 131, 135, 137, 142, 147, 148, 153, 154 Mental Disorders, 66, 142, 147, 153 Mental Health, iv, 5, 66, 102, 104, 147, 153, 154 Metabolite, 127, 128, 137, 147 Metastasis, 147, 148 Metastatic, 34, 70, 140, 147 Methionine, 8, 147, 159 MI, 78, 121, 147 Microbe, 147, 160 Micro-organism, 134, 147 Milliliter, 128, 147

168 Hot Flashes

Modification, 124, 147, 154 Modulator, 80, 147 Molecular, 103, 105, 127, 132, 138, 147, 148, 155, 161 Molecular Structure, 148, 161 Molecule, 68, 125, 126, 132, 135, 139, 148, 150, 155, 156 Monitor, 10, 133, 148 Monocytes, 145, 148 Morphology, 140, 148 Motility, 148, 157 Motion Sickness, 148 Mucins, 148, 156 Musculature, 142, 148 Myocardium, 147, 148 N Naloxone, 35, 148 Nausea, 70, 73, 79, 139, 148, 153 NCI, 1, 59, 61, 62, 63, 64, 65, 101, 148 Need, 3, 4, 5, 6, 73, 74, 75, 83, 86, 92, 112, 123, 148 Neoplasms, 125, 140, 148 Nervous System, 130, 146, 148, 149, 159 Nervousness, 15, 71, 148 Neural, 128, 148 Neuronal, 21, 129, 148 Neurons, 148 Neuropeptide, 128, 149 Neurotensin, 24, 149 Neurotransmitter, 124, 128, 135, 139, 144, 149, 159 Neutrons, 124, 149, 155 Neutrophils, 145, 149 Nitrogen, 125, 149, 161 Norepinephrine, 7, 21, 23, 123, 135, 149 Norethindrone, 20, 149 Nucleus, 126, 133, 134, 136, 146, 148, 149, 153, 154, 158 Nutritive Value, 138, 149 O Oocytes, 72, 149 Oophorectomy, 149, 159 Opacity, 129, 134, 149 Opiate, 148, 149 Optic Chiasm, 142, 149, 159 Oral Health, 4, 150 Orchiectomy, 25, 36, 70, 71, 150, 159 Osteoclasts, 128, 150 Osteoporosis, 3, 4, 5, 23, 24, 31, 53, 61, 64, 68, 69, 76, 77, 80, 81, 84, 108, 111, 137, 150, 155 Ovariectomy, 19, 150

Ovaries, 3, 29, 41, 65, 72, 146, 149, 150, 157, 159 Ovary, 72, 133, 137, 139, 140, 150 Ovulation, 74, 140, 146, 149, 150 Ovum, 133, 150, 153, 162 Oxidation, 10, 123, 126, 127, 133, 150 P Palliative, 46, 71, 133, 150, 160 Pancreas, 9, 123, 127, 134, 144, 150, 161 Panic, 78, 150 Parathyroid, 20, 129, 150, 159 Parathyroid Glands, 150 Parathyroid hormone, 129, 150 Parenteral, 34, 150 Paroxetine, 21, 22, 32, 89, 90, 150, 151 Paroxetine hydrochloride, 22, 151 Patch, 151, 160 Pathologic, 133, 142, 151, 155 Pathophysiology, 7, 41, 51, 151 Pelvic, 136, 151, 153 Pelvis, 150, 151, 161 Penicillin, 124, 151, 161 Peptide, 50, 124, 128, 151, 154 Perimenopausal, 4, 15, 19, 34, 110, 151 Periodontal disease, 77, 151 Periodontitis, 4, 139, 151 Peripheral blood, 10, 63, 151 Perivascular, 128, 151 Perspiration, 72, 134, 151 PH, 128, 151 Pharmaceutic Aids, 138, 151 Pharmaceutical Preparations, 79, 80, 129, 151 Pharmacogenetics, 18, 151 Pharmacokinetic, 151 Pharmacologic, 6, 18, 151, 160 Phenotype, 18, 151 Phenyl, 78, 151 Phospholipids, 137, 145, 152 Phosphorus, 129, 150, 152 Photocoagulation, 131, 152 Physiologic, 7, 124, 130, 142, 147, 152, 155 Physiology, 3, 4, 23, 28, 29, 33, 36, 50, 70, 79, 136, 140, 152 Pilot study, 40, 45, 46, 152 Pineal Body, 152 Pineal gland, 16, 152 Placenta, 137, 152, 153 Plants, 69, 129, 139, 148, 149, 152, 156, 160 Plasma, 23, 31, 50, 72, 128, 129, 130, 138, 141, 145, 152, 156 Pneumonia, 132, 152

Index 169

Poisoning, 139, 148, 152 Polymorphic, 18, 152 Posterior, 124, 130, 150, 152 Postmenopause, 61, 110, 152 Practicability, 137, 152 Practice Guidelines, 104, 153 Preclinical, 48, 153 Precursor, 80, 123, 135, 136, 149, 153, 161 Premenopausal, 29, 153 Premenstrual, 69, 78, 108, 153 Premenstrual Syndrome, 69, 78, 108, 153 Prevalence, 15, 21, 27, 153 Primary Prevention, 11, 153 Progesterone, 4, 7, 55, 149, 153, 158 Progression, 125, 153 Progressive, 33, 137, 140, 153 Projection, 149, 153 Promoter, 68, 153 Prophase, 149, 153 Prospective study, 11, 51, 153 Prostatic Hyperplasia, 154 Protease, 131, 154 Protein C, 19, 126, 145, 154 Protein S, 62, 85, 127, 154 Proteins, 18, 68, 124, 125, 126, 129, 131, 144, 148, 149, 151, 152, 154, 155, 157, 160 Protein-Tyrosine Kinase, 139, 154 Proteolytic, 131, 138, 154 Protocol, 17, 59, 63, 154 Protons, 124, 141, 154, 155 Proximal, 14, 135, 154 Psychiatric, 147, 154, 157 Psychic, 130, 145, 147, 154, 156 Psyllium, 69, 154 Puberty, 69, 92, 154 Public Health, 20, 41, 104, 154 Public Policy, 103, 154 Pulmonary, 127, 130, 132, 154, 162 Pulmonary Artery, 127, 154, 162 Pulmonary Edema, 130, 154 Pulse, 71, 148, 154 Q Quality of Life, 6, 9, 11, 15, 16, 21, 27, 28, 29, 35, 60, 61, 63, 70, 71, 79, 154 R Radiation, 8, 21, 138, 155, 162 Radioactive, 142, 155 Raloxifene, 10, 24, 96, 155, 156 Random Allocation, 155 Randomization, 6, 155

Randomized, 6, 7, 10, 13, 16, 21, 26, 29, 32, 40, 41, 50, 51, 60, 61, 62, 63, 64, 65, 135, 155 Reagent, 130, 155 Receptor, 9, 12, 48, 68, 79, 125, 133, 135, 155, 157 Receptors, Serotonin, 155, 157 Rectum, 126, 128, 134, 138, 143, 145, 154, 155 Recurrence, 127, 130, 155 Red blood cells, 136, 155 Refer, 1, 4, 131, 135, 145, 149, 155 Refraction, 155, 158 Regimen, 4, 7, 60, 61, 135, 155 Remission, 127, 155 Resorption, 150, 155 Respiration, 126, 148, 155 Response rate, 6, 156 Rheumatism, 156 Rheumatoid, 77, 156 Rheumatoid arthritis, 77, 156 Rigidity, 152, 156 Risk factor, 15, 16, 19, 21, 28, 34, 153, 156 S Saliva, 4, 74, 156 Salivary, 134, 156 Salivary glands, 134, 156 Salivation, 139, 156 Sapogenins, 69, 156 Saponin, 156 Screening, 13, 17, 131, 156 Secretion, 35, 130, 140, 144, 148, 151, 156 Sedative, 16, 156 Seizures, 13, 156 Selective estrogen receptor modulator, 11, 19, 80, 155, 156, 159 Semen, 153, 156 Seminiferous tubule, 144, 156 Semisynthetic, 124, 137, 156 Senile, 150, 156 Senna, 129, 156 Serine, 140, 156 Serologic, 143, 157 Serotonin, 7, 9, 20, 21, 48, 123, 138, 149, 150, 155, 157, 161 Serum, 7, 8, 10, 12, 15, 19, 20, 27, 124, 131, 140, 146, 157 Sex Characteristics, 125, 154, 157 Shock, 68, 157 Side effect, 8, 10, 14, 21, 23, 63, 71, 75, 79, 80, 81, 95, 123, 157, 160 Skeletal, 125, 157

170 Hot Flashes

Skeleton, 138, 144, 157 Sleep apnea, 16, 157 Sleep Deprivation, 71, 157 Small intestine, 130, 135, 141, 142, 144, 157 Smooth muscle, 77, 138, 145, 157, 159 Smooth Muscle Tumor, 138, 157 Social Environment, 155, 157 Soft tissue, 128, 157 Solid tumor, 59, 62, 63, 157 Soma, 157, 158 Somatic, 10, 130, 158 Spatial disorientation, 135, 158 Specialist, 112, 158 Species, 46, 74, 135, 136, 139, 158, 159, 162 Specificity, 9, 123, 129, 158 Spectrum, 9, 68, 76, 158 Sperm, 125, 156, 158, 159 Spinal cord, 130, 147, 148, 158 Sterile, 150, 158 Sterility, 23, 26, 27, 31, 143, 158 Sternum, 15, 158 Steroid, 80, 134, 156, 158 Stimulant, 158, 161 Stimulus, 144, 158, 160 Stomach, 123, 134, 137, 138, 139, 141, 148, 157, 158 Stool, 143, 145, 158 Strand, 10, 131, 158 Stress, 57, 71, 129, 138, 139, 148, 156, 158 Stroke, 66, 102, 109, 129, 158 Stromal, 136, 158 Subarachnoid, 140, 158 Subclinical, 143, 156, 159 Subcutaneous, 145, 150, 159 Subspecies, 158, 159 Substance P, 147, 156, 159 Subtrochanteric, 141, 159 Sulfur, 74, 147, 159 Supplementation, 45, 159 Suppression, 65, 159 Suprachiasmatic Nucleus, 16, 159 Surgical castration, 71, 159 Sweat, 134, 151, 159 Sympathomimetic, 135, 136, 149, 159 Symphysis, 130, 153, 159 Symptomatic, 14, 60, 159 Systemic, 4, 96, 127, 136, 143, 159 Systolic, 142, 159 T Tamoxifen, 18, 21, 23, 32, 35, 36, 46, 62, 63, 70, 79, 156, 159 Testicles, 146, 150, 159

Testicular, 27, 68, 76, 159 Testis, 137, 140, 159 Tetany, 150, 159 Therapeutics, 97, 160 Thermoregulation, 70, 79, 160 Threshold, 26, 72, 137, 142, 160 Thrombin, 138, 154, 160 Thrombomodulin, 154, 160 Thrombosis, 12, 154, 158, 160 Thyroid, 128, 150, 160, 161 Thyroid Gland, 150, 160 Tissue, 19, 68, 76, 125, 126, 127, 128, 129, 131, 132, 136, 138, 140, 142, 143, 145, 146, 147, 148, 155, 157, 158, 159, 160, 161 Tomography, 128, 160 Topical, 69, 160 Toxic, iv, 127, 160 Toxicity, 7, 10, 18, 21, 135, 160 Toxicokinetics, 160 Toxicology, 104, 160 Toxins, 125, 129, 143, 160 Trace element, 138, 160 Transdermal, 36, 160 Transfection, 127, 160 Translating, 17, 160 Translation, 124, 160 Transmitter, 135, 144, 146, 149, 161 Tricyclic, 20, 161 Tryptophan, 131, 157, 161 Tumor marker, 127, 161 Tyrosine, 135, 154, 161 U Unconscious, 125, 142, 161 Ureters, 161 Urethra, 127, 153, 161 Urinary, 4, 5, 19, 68, 76, 130, 143, 161 Urinary tract, 4, 5, 161 Urinary tract infection, 4, 161 Urinate, 161, 162 Urine, 12, 14, 17, 20, 127, 133, 137, 143, 161 Uterus, 11, 77, 80, 133, 136, 138, 142, 145, 147, 149, 150, 153, 161 V Vaccine, 123, 154, 161 Vagina, 5, 8, 147, 161 Vaginal, 3, 4, 7, 10, 11, 23, 40, 63, 69, 80, 161 Valine, 73, 161 Vascular, 23, 77, 134, 140, 143, 152, 160, 161 Vasodilator, 128, 135, 161

Index 171

Vasomotor, 7, 12, 19, 46, 71, 72, 80, 137, 161 VE, 23, 49, 161 Venlafaxine, 21, 33, 37, 61, 91, 161 Venous, 154, 162 Ventricle, 142, 152, 154, 159, 162 Vertebrae, 77, 158, 162 Veterinary Medicine, 103, 162 Virulence, 160, 162 Vitro, 162 Vivo, 162 Void, 19, 20, 162

Voltage-gated, 8, 70, 162 W Weight Gain, 92, 110, 162 White blood cell, 125, 145, 146, 162 Womb, 161, 162 X Xenograft, 125, 162 X-ray, 7, 128, 162 Y Yeasts, 151, 162 Z Zymogen, 154, 162

172 Hot Flashes