Muscles A Medical Dictionary Bibliography and Annotated Research Guide to Internet References

Researching Medications 293 Calcium Supplements • Systemic - U.S. Brands: Alka-Mints; Amitone; Calcarb 600; Calci-Chew; Calciday 667; Calcilac; Calci-Mix; Calcionate; Calcium 600; Calglycine; Calphosan; Cal- Plus; Caltrate 600; Caltrate Jr; Chooz; Citracal; Citracal Liquitabs; Dicarbosil; Gencalc 600; Liquid Cal-600 http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202108.html Capreomycin • Systemic - U.S. Brands: Capastat http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202109.html Carbonic Anhydrase Inhibitors • Systemic - U.S. Brands: Ak-Zol; Daranide; Dazamide; Diamox; Diamox Sequels; MZM; Neptazane; Storzolamide http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202114.html Carboprost • Systemic - U.S. Brands: Hemabate http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202116.html Cefuroxime • Systemic - U.S. Brands: Zinacef http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500337.html Cephalosporins • Systemic - U.S. Brands: Ancef; Ceclor; Ceclor CD; Cedax; Cefadyl; Cefditoren; Cefizox; Cefobid; Cefotan; Ceftin; Cefzil; Ceptaz; Claforan; Duricef; Fortaz; Keflex; Keftab; Kefurox; Kefzol; Mandol; Maxipime; Mefoxin; Monocid; Omnicef; Rocephin; Tazicef; Tazidime; Vantin; Velose http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202119.html Chloroquine • Systemic - U.S. Brands: Aralen; Aralen HCl http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202133.html Cisplatin • Systemic - U.S. Brands: Platinol; Platinol-AQ http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202143.html Citrates • Systemic - U.S. Brands: Bicitra; Citrolith; Oracit; Polycitra Syrup; Polycitra-K; Polycitra-K Crystals; Polycitra-LC; Urocit-K http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202144.html Clindamycin • Systemic - U.S. Brands: Cleocin; Cleocin Pediatric http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202145.html

294 Muscles Corticosteroids Glucocorticoid Effects • Systemic - U.S. Brands: Acetocot; A-hydroCort; Amcort; A-MethaPred; Aristocort; Aristocort Forte; Aristopak; Aristospan; Articulose-50; Articulose- L.A.; Celestone; Celestone Phosphate; Celestone Soluspan; Cinalone 40; Cinonide 40; Clinacort; Clinalog; Cordrol; Cortastat http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202018.html Cyclobenzaprine • Systemic - U.S. Brands: Flexeril http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202172.html Dantrolene • Systemic - U.S. Brands: Dantrium; Dantrium Intravenous http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202181.html Deferoxamine • Systemic - U.S. Brands: Desferal http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203185.html Diphtheria and Tetanus Toxoids and Pertussis Vaccine Adsorbed and Haemophilus B Conjugate Vaccine • Systemic - U.S. Brands: Tetramune http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202911.html Diphtheria, Tetanus, Pertussis, Hepatitis B, Poliovirus Vaccine • Systemic - U.S. Brands: Pediarix http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500447.html Doxazosin • Systemic - U.S. Brands: Cardura http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202629.html Entacapone • Systemic - U.S. Brands: Comtan http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500103.html Epirubicin • Systemic - U.S. Brands: Ellence http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500038.html Eprosartan • Systemic - U.S. Brands: Teveten http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500044.html Ergonovine/Methylergonovine • Systemic - U.S. Brands: Ergotrate; Methergine http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202613.html

Researching Medications 295 Ertapenem • Systemic - U.S. Brands: Invanz http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500395.html Factor IX • Systemic - U.S. Brands: AlphaNine SD; Bebulin VH; BeneFix; Konyne 80; Mononine; Profilnine SD; Proplex T http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202674.html Follitropin Beta • Systemic - U.S. Brands: Follistim http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203453.html Fulvestrant • Systemic - U.S. Brands: Faslodex http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500419.html Gemcitabine • Systemic - U.S. Brands: Gemzar http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203038.html Hepatitis A Vaccine Inactivated • Systemic - U.S. Brands: Havrix; Vaqta http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202902.html Hepatitis A Virus Vaccine Inactivated and Hepatitis B Virus Vaccine Recombinant • Systemic - U.S. Brands: Twinrix http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500307.html Hepatitis B Immune Globulin (Human) • Human - U.S. Brands: Nabi-HB http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500325.html Interferon, Beta-1a • Systemic - U.S. Brands: Avonex http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203537.html Magnesium Supplements • Systemic - U.S. Brands: Almora; Chloromag; Citroma; Concentrated Phillips' Milk of Magnesia; Mag-200; Mag-L-100; Magonate; Mag-Ox 400; Mag-Tab SR; Magtrate; Maox; MGP; Phillips' Chewable Tablets; Phillips' Milk of Magnesia; Slow-Mag; Uro-Mag http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202644.html Medroxyprogesterone and Estradiol • Systemic - U.S. Brands: Lunelle http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500255.html

296 Muscles Niacin and Lovastatin • Systemic - U.S. Brands: Advicor http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500381.html Orphenadrine • Systemic - U.S. Brands: Antiflex; Banflex; Flexoject; Mio-Rel; Myolin; Myotrol; Norflex; Orfro; Orphenate http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202426.html Orphenadrine and Aspirin • Systemic - U.S. Brands: N3 Gesic; N3 Gesic Forte; Norgesic; Norgesic Forte; Norphadrine; Norphadrine Forte; Orphenagesic; Orphenagesic Forte http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202427.html Penicillins and Beta-Lactamase Inhibitors • Systemic - U.S. Brands: Augmentin; Timentin; Unasyn; Zosyn http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202705.html Poliovirus Vaccine Live Oral • Systemic - U.S. Brands: Orimune http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203606.html Pralidoxime • Systemic - U.S. Brands: Protopam Chloride http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202779.html Progestins For Contraceptive Use • Systemic - U.S. Brands: Depo-Provera Contraceptive Injection; Micronor; NORPLANT System; Nor-QD; Ovrette; Plan B http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202757.html Progestins For Noncontraceptive Use • Systemic - U.S. Brands: Amen; Aygestin; Crinone; Curretab; Cycrin; Depo- Provera; Gesterol 50; Gesterol LA 250; Hy/Gestrone; Hylutin; Megace; Prodrox; Prometrium; Pro-Span; Provera http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202758.html Rabies Immune Globulin • Systemic - U.S. Brands: BayRab; Hyperab; Imogam; Imogam Rabies-HT http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202718.html Rabies Vaccine • Systemic - U.S. Brands: Imovax; Imovax I.D. http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202719.html Rh o(D) Immune Globulin • D - U.S. Brands: BayRho-D Full Dose; BayRho-D Mini-Dose; MICRhoGAM; RhoGAM; WinRho SDF http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202720.html

Researching Medications 297 Selenium Supplements • Systemic - U.S. Brands: Sele-Pak; Selepen http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202633.html Skeletal Muscle Relaxants • Systemic - U.S. Brands: Carbacot; EZE-DS; Maolate; Paraflex; Parafon Forte DSC; Relaxazone; Remular; Remular-S; Robaxin; Robaxin-750; Skelaxin; Skelex; Soma; Strifon Forte DSC; Vanadom http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202523.html Sodium Oxybate • Systemic - U.S. Brands: Xyrem http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500407.html Spectinomycin • Systemic - U.S. Brands: Trobicin http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202530.html Tamsulosin • Systemic - U.S. Brands: Flomax http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203479.html Terazosin • Systemic - U.S. Brands: Hytrin http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202546.html Tetanus Immune Globulin • Systemic - U.S. Brands: BayTet http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202908.html Tetracyclines • Systemic - U.S. Brands: Achromycin V; Declomycin; Doryx; Dynacin; Minocin; Monodox; Terramycin; Vibramycin; Vibra-Tabs http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202552.html Thiamine (Vitamin B 1) • Vitamin B 1 - U.S. Brands: Biamine http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202560.html Thiethylperazine • Systemic - U.S. Brands: Torecan http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202561.html Thioxanthenes • Systemic - U.S. Brands: Navane; Taractan; Thiothixene HCl Intensol http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202564.html

298 Muscles Thyroid Hormones • Systemic - U.S. Brands: Armour Thyroid; Cytomel; Levo-T; Levothroid; Levoxyl; Synthroid; Thyrar; Thyroid Strong; Thyrolar; Triostat; Westhroid http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202566.html Tizanidine • Systemic - U.S. Brands: Zanaflex http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/207060.html Trimethobenzamide • Systemic - U.S. Brands: Benzacot; Stemetic; Tebamide; Tigan; Tribenzagan; Trimazide http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202578.html Triptorelin • Systemic - U.S. Brands: Trelstar Depot http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500209.html Typhoid Vi Polysaccharide Vaccine • Systemic - U.S. Brands: Typhim Vi http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202763.html Urofollitropin • Systemic - U.S. Brands: Fertinex; Metrodin http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202586.html Vasopressin • Systemic - U.S. Brands: Pitressin http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202591.html Vitamin E • Systemic - U.S. Brands: Amino-Opti-E; Aquasol E; E-1000 I.U. Softgels; E-200 I.U. Softgels; E-400 I.U. in a Water Soluble Base; E-Complex-600; E-Vitamin Succinate; Liqui-E; Pheryl-E; Vita Plus E http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202598.html Vitamin K • Systemic - U.S. Brands: AquaMEPHYTON; Mephyton http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202599.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.

Researching Medications 299 Mosby’s Drug Consult Mosby’s Drug Consult database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/. PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html. Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee. Researching Orphan Drugs Although the list of orphan drugs is revised on a daily basis, you can quickly research orphan drugs that might be applicable to muscles by using the database managed by the National Organization for Rare Disorders, Inc. (NORD), at http://www.rarediseases.org/. Scroll down the page, and on the left toolbar, click on “Orphan Drug Designation Database.” On this page (http://www.rarediseases.org/search/noddsearch.html), type “muscles” (or synonyms) into the search box, and click “Submit Query.” When you receive your results, note that not all of the drugs may be relevant, as some may have been withdrawn from orphan status. Write down or print out the name of each drug and the relevant contact information. From there, visit the Pharmacopeia Web site and type the name of each orphan drug into the search box at http://www.nlm.nih.gov/medlineplus/druginformation.html. You may need to contact the sponsor or NORD for further information. NORD conducts “early access programs for investigational new drugs (IND) under the Food and Drug Administration’s (FDA’s) approval ‘Treatment INDs’ programs which allow for a limited number of individuals to receive investigational drugs before FDA marketing approval.” If the orphan product about which you are seeking information is approved for marketing, information on side effects can be found on the product’s label. If the product is not approved, you may need to contact the sponsor. The following is a list of orphan drugs currently listed in the NORD Orphan Drug Designation Database for muscles: • Botulinum toxin type A (trade name: Botox) http://www.rarediseases.org/nord/search/nodd_full?code=607

300 Muscles • Botulinum toxin type A (trade name: Botox) http://www.rarediseases.org/nord/search/nodd_full?code=614 • Botulinum toxin type A (trade name: Dysport) http://www.rarediseases.org/nord/search/nodd_full?code=997 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.

301 APPENDICES



303 APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience. NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute10: • Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm • National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/ • National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html • National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c- 714a9f7c8d25 • National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm • National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm • National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375 • National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/ 10 These publications are typically written by one or more of the various NIH Institutes.

304 Muscles • National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm • National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/ • National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm • National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm • National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/ • National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/ • National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm • National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html • National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm • National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm • National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm • National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html • National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm • Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp • National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/ • National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp • Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html • Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

Physician Resources 305 NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.11 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:12 • Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html • HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html • NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html • Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/ • Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html • Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html • Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/ • Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html • Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html • Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html • MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html 11 Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 12 See http://www.nlm.nih.gov/databases/databases.html.

306 Muscles • Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html • Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html The NLM Gateway13 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.14 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “muscles” (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 Items Found Journal Articles 432148 Books / Periodicals / Audio Visual 2904 Consumer Health 1065 Meeting Abstracts 119 Other Collections 853 437089 Total HSTAT15 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.16 These documents include clinical practice guidelines, quick- reference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.17 Simply search by “muscles” (or synonyms) at the following Web site: http://text.nlm.nih.gov. 13 Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x. 14 The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 15 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 16 The HSTAT URL is http://hstat.nlm.nih.gov/. 17 Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.

Physician Resources 307 Coffee Break: Tutorials for Biologists18 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.19 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.20 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/. Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: • CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/. • Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/. The Genome Project and Muscles In the following section, we will discuss databases and references which relate to the Genome Project and muscles. Online Mendelian Inheritance in Man (OMIM) The Online Mendelian Inheritance in Man (OMIM) database is a catalog of human genes and genetic disorders authored and edited by Dr. Victor A. McKusick and his colleagues at Johns Hopkins and elsewhere. OMIM was developed for the World Wide Web by the National Center for Biotechnology Information (NCBI).21 The database contains textual information, pictures, and reference information. It also contains copious links to NCBI’s Entrez database of MEDLINE articles and sequence information. 18 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. 19 The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 20 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process. 21 Adapted from http://www.ncbi.nlm.nih.gov/. Established in 1988 as a national resource for molecular biology information, NCBI creates public databases, conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information--all for the better understanding of molecular processes affecting human health and disease.

308 Muscles To search the database, go to http://www.ncbi.nlm.nih.gov/Omim/searchomim.html. Type “muscles” (or synonyms) into the search box, and click “Submit Search.” If too many results appear, you can narrow the search by adding the word “clinical.” Each report will have additional links to related research and databases. In particular, the option “Database Links” will search across technical databases that offer an abundance of information. The following is an example of the results you can obtain from the OMIM for muscles: • Abdominal Muscles, Absence Of, with Urinary Tract Abnormality and Cryptorchidism Web site: http://www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=100100 • Actin, Alpha, Skeletal Muscle 1 Web site: http://www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=102610 • Aplasia of Extensor Muscles of Fingers, Unilateral, with Generalized Polyneuropathy Web site: http://www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=207740 • Axenfeld-rieger Anomaly with Partially Absent Eye Muscles, Distinctive Face, Hydrocephaly, and Skeletal Abnormalities Web site: http://www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=109120 • Central Core Disease of Muscle Web site: http://www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=117000 • Chloride Channel 1, Skeletal Muscle Web site: http://www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=118425 • Creatine Kinase, Muscle Type Web site: http://www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=123310 • Depressor Anguli Oris Muscle, Hypoplasia of Web site: http://www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=125520 • Dwarfism, Familial, with Muscle Spasms Web site: http://www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=600771 • Fibrosis of Extraocular Muscles, Congenital, 1 Web site: http://www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=135700 • Fibrosis of Extraocular Muscles, Congenital, 2 Web site: http://www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=602078 • Fibrosis of Extraocular Muscles, Congenital, 3 Web site: http://www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=600638 • Fibrosis of Extraocular Muscles, Congenital, 3a Web site: http://www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=607034 • Gluteal Muscles, Absence of Web site: http://www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=231970 • Masticatory Muscles, Hypertrophy of Web site: http://www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=154850 • Muscle, Skeletal, Receptor Tyrosine Kinase Web site: http://www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=601296 • Myopathy, Proximal, with Early Respiratory Muscle Involvement Web site: http://www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=603689

Physician Resources 309 • Myosin, Heavy Chain 1, Skeletal Muscle, Adult Web site: http://www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=160730 • Myosin, Heavy Chain 16, Skeletal Muscle, Pseudogene Web site: http://www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=608580 • Myosin, Heavy Chain 8, Skeletal Muscle, Perinatal Web site: http://www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=160741 • Myosin, Skeletal Muscle, Heavy Chain 13 Web site: http://www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=603487 • Ossified Ear Cartilages with Mental Deficiency, Muscle Wasting, and Bony Changes Web site: http://www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=259050 • Phosphorylase Kinase, Muscle, Alpha-1 Subunit Web site: http://www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=311870 • Rippling Muscle Disease Web site: http://www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=606072 Genes and Disease (NCBI - Map) The Genes and Disease database is produced by the National Center for Biotechnology Information of the National Library of Medicine at the National Institutes of Health. This Web site categorizes each disorder by system of the body. Go to http://www.ncbi.nlm.nih.gov/disease/, and browse the system pages to have a full view of important conditions linked to human genes. Since this site is regularly updated, you may wish to revisit it from time to time. The following systems and associated disorders are addressed: • Cancer: Uncontrolled cell division. Examples: Breast and ovarian cancer, Burkitt lymphoma, chronic myeloid leukemia, colon cancer, lung cancer, malignant melanoma, multiple endocrine neoplasia, neurofibromatosis, p53 tumor suppressor, pancreatic cancer, prostate cancer, Ras oncogene, RB: retinoblastoma, von Hippel-Lindau syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Cancer.html • Immune System: Fights invaders. Examples: Asthma, autoimmune polyglandular syndrome, Crohn’s disease, DiGeorge syndrome, familial Mediterranean fever, immunodeficiency with Hyper-IgM, severe combined immunodeficiency. Web site: http://www.ncbi.nlm.nih.gov/disease/Immune.html • Metabolism: Food and energy. Examples: Adreno-leukodystrophy, atherosclerosis, Best disease, Gaucher disease, glucose galactose malabsorption, gyrate atrophy, juvenile-onset diabetes, obesity, paroxysmal nocturnal hemoglobinuria, phenylketonuria, Refsum disease, Tangier disease, Tay-Sachs disease. Web site: http://www.ncbi.nlm.nih.gov/disease/Metabolism.html • Muscle and Bone: Movement and growth. Examples: Duchenne muscular dystrophy, Ellis-van Creveld syndrome, Marfan syndrome, myotonic dystrophy, spinal muscular atrophy. Web site: http://www.ncbi.nlm.nih.gov/disease/Muscle.html

310 Muscles • Nervous System: Mind and body. Examples: Alzheimer disease, amyotrophic lateral sclerosis, Angelman syndrome, Charcot-Marie-Tooth disease, epilepsy, essential tremor, fragile X syndrome, Friedreich’s ataxia, Huntington disease, Niemann-Pick disease, Parkinson disease, Prader-Willi syndrome, Rett syndrome, spinocerebellar atrophy, Williams syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Brain.html • Signals: Cellular messages. Examples: Ataxia telangiectasia, Cockayne syndrome, glaucoma, male-patterned baldness, SRY: sex determination, tuberous sclerosis, Waardenburg syndrome, Werner syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Signals.html • Transporters: Pumps and channels. Examples: Cystic fibrosis, deafness, diastrophic dysplasia, Hemophilia A, long-QT syndrome, Menkes syndrome, Pendred syndrome, polycystic kidney disease, sickle cell anemia, Wilson’s disease, Zellweger syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Transporters.html Entrez Entrez is a search and retrieval system that integrates several linked databases at the National Center for Biotechnology Information (NCBI). These databases include nucleotide sequences, protein sequences, macromolecular structures, whole genomes, and MEDLINE through PubMed. Entrez provides access to the following databases: • 3D Domains: Domains from Entrez Structure, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo • Books: Online books, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=books • Genome: Complete genome assemblies, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Genome • NCBI’s Protein Sequence Information Survey Results: Web site: http://www.ncbi.nlm.nih.gov/About/proteinsurvey/ • Nucleotide Sequence Database (Genbank): Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Nucleotide • OMIM: Online Mendelian Inheritance in Man, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=OMIM • PopSet: Population study data sets, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Popset • ProbeSet: Gene Expression Omnibus (GEO), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo • Protein Sequence Database: Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Protein • PubMed: Biomedical literature (PubMed), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed

Physician Resources 311 • Structure: Three-dimensional macromolecular structures, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Structure • Taxonomy: Organisms in GenBank, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Taxonomy To access the Entrez system at the National Center for Biotechnology Information, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=genome, and then select the database that you would like to search. The databases available are listed in the drop box next to “Search.” Enter “muscles” (or synonyms) into the search box and click “Go.” Jablonski’s Multiple Congenital Anomaly/Mental Retardation (MCA/MR) Syndromes Database22 This online resource has been developed to facilitate the identification and differentiation of syndromic entities. Special attention is given to the type of information that is usually limited or completely omitted in existing reference sources due to space limitations of the printed form. At http://www.nlm.nih.gov/mesh/jablonski/syndrome_toc/toc_a.html, you can search across syndromes using an alphabetical index. Search by keywords at http://www.nlm.nih.gov/mesh/jablonski/syndrome_db.html. The Genome Database23 Established at Johns Hopkins University in Baltimore, Maryland in 1990, the Genome Database (GDB) is the official central repository for genomic mapping data resulting from the Human Genome Initiative. In the spring of 1999, the Bioinformatics Supercomputing Centre (BiSC) at the Hospital for Sick Children in Toronto, Ontario assumed the management of GDB. The Human Genome Initiative is a worldwide research effort focusing on structural analysis of human DNA to determine the location and sequence of the estimated 100,000 human genes. In support of this project, GDB stores and curates data generated by researchers worldwide who are engaged in the mapping effort of the Human Genome Project (HGP). GDB’s mission is to provide scientists with an encyclopedia of the human genome which is continually revised and updated to reflect the current state of scientific knowledge. Although GDB has historically focused on gene mapping, its focus will broaden as the Genome Project moves from mapping to sequence, and finally, to functional analysis. To access the GDB, simply go to the following hyperlink: http://www.gdb.org/. Search “All Biological Data” by “Keyword.” Type “muscles” (or synonyms) into the search box, and 22 Adapted from the National Library of Medicine: http://www.nlm.nih.gov/mesh/jablonski/about_syndrome.html. 23 Adapted from the Genome Database: http://gdbwww.gdb.org/gdb/aboutGDB.html - mission.

312 Muscles review the results. If more than one word is used in the search box, then separate each one with the word “and” or “or” (using “or” might be useful when using synonyms).

313 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 muscles 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 muscles. 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 muscles. 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 “muscles”:

314 Muscles • Guides on muscles Muscle Disorders http://www.nlm.nih.gov/medlineplus/muscledisorders.html Muscles http://www.nlm.nih.gov/medlineplus/tutorials/musclesloader.html • Other guides Anatomy http://www.nlm.nih.gov/medlineplus/anatomy.html Muscular Dystrophy http://www.nlm.nih.gov/medlineplus/musculardystrophy.html Neuromuscular Disorders http://www.nlm.nih.gov/medlineplus/neuromusculardisorders.html Sprains and Strains http://www.nlm.nih.gov/medlineplus/sprainsandstrains.html Within the health topic page dedicated to muscles, the following was listed: • Diagnosis/Symptoms Electromyography and Nerve Conduction Velocities Source: Muscular Dystrophy Association http://www.mdausa.org/publications/Quest/q75ss.html Glossary of Orthopaedic Diagnostic Tests Source: American Academy of Orthopaedic Surgeons http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=372&topcategory=Abou t%2520Orthopaedics MR Imaging (MRI)-Musculoskeletal Source: American College of Radiology, Radiological Society of North America http://www.radiologyinfo.org/content/mr_musculoskeletal.htm Muscle Biopsies Source: Muscular Dystrophy Association http://www.mdausa.org/publications/Quest/q74ss.html Stiffness, Cramps and Twitching Source: Muscular Dystrophy Association http://www.mdausa.org/publications/Quest/q73ss.html Ultrasound-Musculoskeletal Source: American College of Radiology, Radiological Society of North America http://www.radiologyinfo.org/content/ultrasound-muscskel.htm • Treatment Botulinum Toxin Injections: A Treatment for Muscle Spasms Source: American Academy of Family Physicians http://familydoctor.org/017.xml

Patient Resources 315 Injections Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=PN00046 • Specific Conditions/Aspects Compartment Syndrome Source: American Academy of Orthopaedic Surgeons http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=287&topcategory=Abou t%2520Orthopaedics Metabolic Diseases of Muscle Source: Muscular Dystrophy Association http://www.mdausa.org/publications/fa-metab.html Multifocal Motor Neuropathy Source: National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov/health_and_medical/disorders/multifocal_neuropathy .htm Muscle Contusion (Bruise) Source: American Academy of Orthopaedic Surgeons http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=316&topcategory=Sport s Muscle Cramp Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=DS00311 Myofascial Pain Syndrome Source: Beth Israel Medical Center, Dept. of Pain Medicine and Palliative Care http://stoppain.org/pain_medicine/myofascial.html Myopathies Source: Muscular Dystrophy Association http://www.mdausa.org/publications/fa-myop.html Myopathy Source: National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov/health_and_medical/disorders/myopathy.htm Myotonia Source: National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov/health_and_medical/disorders/myotonia.htm Myotonia Congenita Source: National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov/health_and_medical/disorders/myotoniacongenita.ht m Periodic Paralyses Source: National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov/health_and_medical/disorders/periodic_doc.htm

316 Muscles • Children Congenital Myopathies Source: National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov/health_and_medical/disorders/myopathy_congenital. htm Hypotonia Source: National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov/health_and_medical/disorders/hypotonia.htm Straight Talk About Curved Joints: Help for Patients with Arthrogryposis Source: Shriners Hospitals for Children http://www.shrinershq.org/patientedu/arthrogryposis1.html What is Arthrogryposis? Source: Shriners Hospitals for Children http://www.shrinershq.org/patientedu/arthrogryposis.html Your Multi-Talented Muscles Source: Nemours Foundation http://kidshealth.org/kid/body/muscles_noSW.html • Organizations American Academy of Orthopaedic Surgeons http://www.aaos.org/ Muscular Dystrophy Association http://www.mdausa.org/ National Institute of Arthritis and Musculoskeletal and Skin Diseases http://www.niams.nih.gov/ National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov/ • Research Muscle Abnormalities in Four Patients Taking Statins To Treat Unfavorable Cholesterol Levels Source: American College of Physicians http://www.annals.org/cgi/content/full/137/7/I-45 Muscle Biology Research Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases http://www.niams.nih.gov/an/stratplan/musclebio.htm • Teenagers Bones, Muscles, and Joints Source: Nemours Foundation http://kidshealth.org/teen/your_body/body_basics/bones_muscles_joints.html You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the

Patient Resources 317 exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on muscles. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: • Disorders Related to Excessive Pelvic Floor Muscle Tension Source: Milwaukee, WI: International Foundation for Functional Gastrointestinal Disorders. 1993. 2 p. Contact: Available from International Foundation for Functional Gastrointestinal Disorders (IFFGD). P.O. Box 170864, Milwaukee, WI 53217. (888) 964-2001 or (414) 964- 1799. Fax (414) 964-7176. E-mail: [email protected]. Website: www.iffgd.org. PRICE: $0.50. Summary: Disorders which have excessive pelvic floor muscle activity as their primary feature are often not recognized and diagnosed by physicians. This fact sheet briefly explains the role of the pelvic floor muscles and some symptoms related to the presence of elevated tension in these muscles, and then describes various treatment options available. The pelvic floor muscles are normally under voluntary control and the involuntary smooth muscle of the bladder, rectum, and colon is actually inhibited through the voluntary contraction of the pelvic floor muscles. The author considers the disorders that are associated with elevated levels of pelvic muscle activity, including proctalgia fugax, levator ani syndrome, cocccydinia, pelvic floor tension myalgia, anismus, and voiding dysfunction. Excessive pelvic floor muscle tension can also contribute to the development of various other conditions. When one defecates and strains against an unrelaxed and closed anal canal, a considerable mechanical stress is placed upon the structures of the pelvic floor. Over time, chronic straining can advance the development of anal fissures, hemorrhoids, rectocele, solitary rectal ulcer, and perineal descent. Biofeedback is a promising treatment for disorders related to excessive pelvic floor tension because it has the potential to alter the disordered muscle activity, changing life-long muscle patterns toward those associated with healthy bowel and bladder habits. Other conservative treatments include physiotherapy modalities such as rectal diathermy, hydrotherapy, massage, and postural adjustments. Drug therapy can also be utilized. The author encourages readers to obtain a thorough evaluation and diagnosis of any potential pelvic muscle dysfunction. (AA-M). • Exercising Your Pelvic Muscles Source: American Family Physician. 62(11): 2447. December 1, 2000. Contact: Available from American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237. Website: www.aafp.org. Summary: This brief fact sheet reviews the use of pelvic muscle exercises (Kegel exercises) for women who have urinary incontinence (involuntary leakage of urine).

318 Muscles Pelvic muscles help stop the flow of urine, but pregnancy, childbirth, and being overweight can weaken the pelvic muscles. Women who leak urine may have better control of these muscles by doing Kegel exercises. The fact sheet describes the muscles that control the bladder and outlines the recommendations for exercising and strengthening these muscles. The fact sheet stresses that daily exercise can strengthen bladder control. The fact sheet also recommends that readers tighten their pelvic muscles before sneezing, lifting, or jumping; this can prevent pelvic muscle damage and urine leakage. The fact sheet includes a brief exercise log form where readers can record their daily exercise routine. 1 figure. • Pelvic Muscle Exercise (PME) Source: Olivette, MO: Home Delivery Incontinent Supplies Company, Inc. 2002. 2 p. Contact: Available from Home Delivery Incontinent Supplies Company, Inc. 9385 Dielman Industrial Drive, Olivette, MO 63132. (800) 269-4663. Website: www.hdis.com. PRICE: Single copy free. Summary: This brochure describes how the use of pelvic muscle exercises (PME, or Kegel exercises) can be used to help manage urinary incontinence (involuntary loss of urine). The brochure notes that incontinence has many causes, one of which is weakened pelvic muscles. These muscles can be weakened by pregnancy and childbirth, menopause, aging, or prostate surgery. PME is a series of contractions designed to strengthen the two major muscles which stretch across the pelvic floor. The brochure describes how exercising these muscles can be helpful to bladder control, and then walks readers step by step through performing PME. A tear off sheet is included with which readers can request bladder control and related products from the Home Delivery Incontinent Supplies company. 2 figures. • Pelvic Muscle Exercises to Improve Your Bladder Control Source: Spartanburg, SC: National Association for Continence (NAFC). 199x. 2 p. Contact: Available from National Association for Continence (NAFC). P.O. Box 8310, Spartanburg, SC 29305-8310. (800) BLADDER or (864) 579-7900. Fax (864) 579-7902. PRICE: $1.00 plus $1.00 shipping and handling. Summary: This brochure describes the use of pelvic muscle exercises (Kegel exercises), designed to help people with urinary incontinence help themselves. The brochure stresses that, through regular exercise, the pelvic muscles can be built up in strength and endurance and the result is improved bladder control. Topics include how to locate the muscles to be exercised, the recommended pattern of exercises, helpful tips, when improvement can be expected, making pelvic muscle exercises a part of one's daily routine, and ten healthy habits to improve bladder control. An example of an exercise and voiding chart is also included. • Pelvic Muscle Exercises: Exercises Specifically for the Pelvic Floor Source: Spartanburg, SC: National Association for Continence (NAFC). 1997. 4 p. Contact: National Association for Continence (NAFC). P.O. Box 8310, Spartanburg, SC 29305-8310. (800) 252-3337 or (864) 579-7900. Fax (864) 579-7902. PRICE: $1.00. Summary: This brochure provides basic information about pelvic muscle exercises, an important part of the behavioral treatment techniques that help increase bladder control and decrease bladder leakage. Topics include the physiology of the pelvic floor muscles,

Patient Resources 319 how to find and recognize the muscles, suggested exercises, a suggested exercise schedule, when to do the pelvic muscle exercises, and working with a health care provider. 2 figures. • Joint and Muscle Pain in Systemic Lupus Erythematosus (SLE) Source: Washington, DC: Lupus Foundation of America. 2003. 6 p. Contact: Available from Lupus Foundation of America. 2000 L. St., Suite 710, Washington, DC 20036-4916. (202) 349-1155 or (800) 558-0121. (800) 558-0231 (information in Spanish). Fax: (202) 349-1156. Website: www.lupus.org. Summary: This brochure provides information about joint and muscle pain to patients with systemic lupus erythematosus (SLE). More than 90 percent of patients with SLE will experience joint and/or muscle pain during the course of their illness. The main cause of joint pain is inflammation, which results in pain, swelling, tenderness, warmth, and fluid collection in the joint. Pain in or around the joints may also be due to other medical disorders, including fibromyalgia, avascular necrosis, tendinitis and bursitis, and other types of arthritis. Myositis (inflammation of skeletal muscle) may develop in patients with SLE. Symptoms of lupus myositis include muscle pain in the neck, pelvic girdle and thighs, shoulder girdle, and upper arms, and weakness. Diagnosis is confirmed by certain enzymes in the blood and abnormalities in the electromyogram test (a test which measures the electrical activity of muscle fibers). Corticosteroids are used to treat lupus myositis. Immunosuppressive drugs are prescribed for patients who do not respond to prednisone. Exercise may also help patients to regain muscle strength and function. Physicians should rule out drug-induced muscle disease (a possible side- effect of medications such as prednsone and other corticosteroids) as a cause of weakness in patients with SLE. • Botulinum Toxin Injections: A Treatment for Muscle Spasms Source: American Academy of Family Physicians. February 2003. 2 p. Contact: Available online from American Academy of Family Physicians. Website: http://familydoctor.org. Summary: This fact sheet discusses the use of botulinum toxin to stop muscle spasms that occur in the face, head, or eye. This treatment is used for a number of conditions including spasmodic torticollis and lazy eye. The botulinum toxin is administered by injection in small doses and works by stopping the chemical messages sent from nerves. Soreness at the injection sight may occur after treatment and can be treated with nonprescription medications such as acetaminophen or ibuprofen or with an ice pack. Other short-term side effects may include weakness in the injected muscles, rash, muscle soreness throughout the body, or difficulty swallowing. • Four Exercises to Strengthen the Muscles of Your Rotator Cuff Source: American Family Physician. 57(4): 680-681. February 15, 1998. Contact: American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237 or (913) 906-6000. E-mail: [email protected]. Website: www.aafp.org. Summary: This journal article for people who have injured their shoulder provides them with information on four exercises to strengthen the muscles of the shoulder, particularly the rotator cuff. Each exercise is accompanied by illustrations depicting the

320 Muscles proper way to perform the exercise. Guidelines for performing these exercises include performing each exercise slowly, looking at the accompanying pictures to follow the proper position, repeating each exercise until the arm is tired, performing all exercises three to five times a week, and applying an ice pack to the shoulder for 20 minutes following completion of the exercises. 4 figures. • Dealing With Joint or Muscle Pain Source: Nurse Practitioner. 26(7): 23. July 2001. Summary: This journal article uses a question and answer format to provide people who have muscle or joint pain with information on managing pain caused by misuse syndrome, an injury that damages tendons, ligaments, and other soft tissues as a result of not using muscles correctly. The article explains how a health care provider evaluates a misuse injury, how misuse syndrome is treated, and how it can be prevented. The article also discusses the protection, rest, ice, compression, and elevation (PRICE) method of helping an injury heal. • Continence Facts: Pelvic Muscle Exercises: Kegel Exercises for Urinary Incontinence Source: Westmount, Quebec: Canadian Continence Foundation. 2000. 2 p. Contact: Canadian Continence Foundation. B.P/P.O. 30, Succ. Victoria Branch, Westmount, Quebec, Canada, H3Z 2V4. (514) 488-8379. Email: [email protected]. Website: www.continence-fdn.ca. PRICE: $2.00; bulk copies available. Summary: Urinary incontinence (UI) is the loss of bladder control. This fact sheet helps readers who are experiencing urine leakage to learn about the use of pelvic floor muscle exercises (Kegel exercises) that may be used for treating incontinence in both women and men of all ages. The fact sheet describes how pelvic muscle exercises may help and stresses the importance of working with a health care professional for UI concerns, as incontinence can almost always be cured, treated, or managed successfully. The fact sheet then outlines exactly how to do the pelvic muscle exercises (for men and for women), as well as a recommended schedule. Readers are encouraged to contact their health care provider if they are needing assistance with identifying the correct pelvic floor muscles; biofeedback can be used to identify and exercise the pelvic muscles. The brochure includes the contact information for the Canadian Continence Foundation (TCCF). 3 figures. The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search this site located at http://www.guideline.gov/ by using the keyword “muscles” (or synonyms). The following was recently posted: • Management of non-muscle-invasive bladder cancer Source: American Urological Association, Inc. - Medical Specialty Society; 1999; 66 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2143&nbr=1369&a mp;string=muscle

Patient Resources 321 • Use of adjuvant chemotherapy following cystectomy in patients with deep muscle- invasive transitional cell carcinoma of the bladder Source: Practice Guidelines Initiative - State/Local Government Agency [Non-U.S.]; 2001 October 9 (revised online 2003 January 22); 18 pages http://www.guideline.gov/summary/summary.aspx?doc_id=4263&nbr=3263&a mp;string=muscle Healthfinder™ Healthfinder™ is sponsored by the U.S. Department of Health and Human Services and offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: • Exercising Your Pelvic Muscles Source: National Kidney and Urologic Diseases Information Clearinghouse, National Institute of Diabetes and Digestive and Kidney Disease http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=7760 • Fibromyalgia Syndrome Summary: Fibromyalgia Syndrome (FMS) is a disorder causing pain, tenderness, and stiffness in the muscles. Source: American Occupational Therapy Association http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=7314 • Muscular Dystrophy Summary: Muscular dystrophy (MD) refers to a group of genetic diseases characterized by progressive weakness and degeneration of the skeletal or voluntary muscles which control movement. Source: National Institute of Neurological Disorders and Stroke, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=749 • Why Exercise is Cool Summary: Important reasons why exercise is good for kids and why it is cool to be fit. Find out what exercise does for your heart, your muscles and your general health. Source: Nemours Foundation http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=5824 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

322 Muscles ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to muscles. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: • AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats • Family Village: http://www.familyvillage.wisc.edu/specific.htm • Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/ • Med Help International: http://www.medhelp.org/HealthTopics/A.html • Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/ • Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/ • WebMDHealth: http://my.webmd.com/health_topics News Services and Press Releases One of the simplest ways of tracking press releases on muscles 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 “muscles” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to muscles. 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 “muscles” (or synonyms).

Patient Resources 323 The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “muscles” (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 “muscles” (or synonyms). If you know the name of a company that is relevant to muscles, 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 “muscles” (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

324 Muscles 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 “muscles” (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 muscles: • Muscle Cramps: Do They Cramp Your Style? Source: Fit Society Page. p. 7. Summer 2001. Contact: American College of Sports Medicine, P.O. Box 1440, Indianapolis, IN 46206- 1440. Summary: Muscle cramps are poorly understood. Only recently have researchers found a way to cause cramps that may open the door for research on ways to prevent them. Muscle cramps commonly occur among athletes who work their muscles to the point of exhaustion. This intensity is likely related to over stimulation of the nerves that trigger the muscles to contract. Popular remedies to relieve cramps include massage, stretching, and acupressure. Although nutrition may not play a role, Clark provides a few food tips to help rule out theoretical nutritional causes. His first theory is lack of water followed by lack of calcium, sodium, and potassium. Some football players and athletic trainers also endorse pickle juice. The remedy is 2 ounces of pickle juice taken 10 minutes before exercise. Clark notes that although none of these theories are proven solutions, none will cause harm. • The Mystery of Sore Muscles Source: Running and FitNews. 15(2):4-5; Feb 1997. Contact: American Running and Fitness Association, 4405 East West Highway, Suite 405, Bethesda, MD 20814. (800) 776-ARFA (2732). Summary: This article explains some of the causes of sore muscles, how to prevent them, and how to treat them. The author stresses that scientists still do not now much about how muscle forms or develops. The difference between eccentric and concentric exercise is described, and suggestions are given for preventing sore muscles. • Your Muscles Need Work Source: Consumer Reports on Health. 13(5):1, 4-5. May 2001. Contact: Consumers Union of United States, Inc., 101 Truman Avenue, Yonkers, NY 1073-1057. Summary: This article recommends strength training in addition to aerobic activity for middle-aged and older people. Experts such as Miriam Nelson, director of the Center for Physical Fitness at Tufts University, advise that the older one becomes, the more evenly one should divide time between aerobic exercise and strength training. Strength begins to decline in the thirties and is eventually responsible for the weaknesses and disabilities associated with old age. Physical activity can help slow this process. The authors review the benefits of strong muscles including making life easier, increasing metabolism, building stronger bones, improving digestion, relieving back pain, and managing diabetes. They discuss strategies for safe training and injury prevention. A sidebar provides an at-home workout that exercises the major muscle groups in the arms, legs,

Patient Resources 325 shoulders, chest, back, and abdomen. It recommends three strength-building workouts a week to ensure maximum benefits. • Nutrition: Preserving Muscle and Providing Energy for Rehabilitation Source: Renal Rehabilitation Report. 6(3): 7. May-June 1998. Contact: Available from Life Options Rehabilitation Program. Medical Education Institute, Inc, 414 D'Onofrid Drive., Suite 200, Madison, WI 53719. (608) 833-8033. E- mail: [email protected]. Summary: This brief article reviews the role of nutrition in patients with end-stage renal disease (ESRD), particularly the importance of adequate nutrition as a prerequisite for rehabilitation. Dialysis patients have an increased need for protein, however, due to such factors as anorexia, nausea, comorbid conditions, or restrictive and unpalatable diets, they often have difficulty taking in enough protein to meet this increased need. When inadequate dietary protein is combined with chronic renal failure, patients often experience loss of lean tissue mass (muscle), muscle fiber deterioration, and decreased muscle function. The article emphasizes that the need for adequate dietary protein intake must be balanced with other aspects of the renal diet, including control of sodium, potassium, calcium, phosphorus, fluids, and in the case of patients with diabetes, simple sugars. The article briefly discusses the use of recommendations for the assessment and monitoring of patients nutritional status. The article concludes that good nutrition can prevent or reverse the effects of malnutrition, enabling patients to preserve the strength and energy they need for rehabilitation. 5 references. • Muscle Cramps: Common and Often Manageable Source: Mayo Clinic Health Letter. 22(2): 6. February 2004. Contact: Available from Mayo Foundation for Medical Education and Research. 200 First St. SW, Rochester, MN 55905. Summary: This newsletter article discusses the causes and prevention of muscle cramps in the lower leg. Muscle cramps are common in athletes and older adults. Common causes of muscle cramps include muscle overuse or strain, dehydration, low levels of blood calcium, low levels of potassium in the body, and the use of certain medications. Less commonly, muscle cramps may be caused by peripheral nerve disease or amyotrophic lateral sclerosis. Individuals with severe, frequent muscle cramps should consult their doctor. Methods for preventing or curbing muscle cramps include drinking fluids to avoid dehydration, warming up before exercising and stretching afterwards, stretching before going to bed, and not overworking muscles. During a muscle cramp, individuals should gently stretch the contracted muscle for relief. Quinine may help relieve cramping for individuals whose cramps do not respond to preventive measures. • Referred Pain and Hyperalgesia Related to Muscle and Visceral Pain Source: Lifeline: The Newsletter of the National Chronic Pain Outreach Association. p. 10-13. Summer 1999. Contact: Available from National Chronic Pain Outreach Association. P.O. Box 274, Millboro, VA 24460. (540) 862-9437. Fax (540) 862-9485. E-mail: [email protected]. Summary: This newsletter article for health professionals and people who have chronic pain reviews current knowledge of referred pain and hyperalgesia from muscle and visceral pain. Hyperplasia from deep tissue can be detected as increased pain responses

326 Muscles to normally nonpainful stimuli or increased pain to normally painful stimuli. Research on muscle pain indicates that at least two mechanisms may be operating during local and referred muscle pain. Central hyperexcitability is one mechanism that may be involved in the generation of referred pain. This mechanism generates referred pain and increased modality specific responses. In another mechanism, descending or segmental inhibition modulates the sensory neurons in the dorsal horn. These mechanisms may be competitive, resulting in the complex sensory findings involved in muscle pain. The extent of referred pain is related to the degree and duration of continuing pain and the degree of central hyperexcitability. Temporal summation may be strongly facilitated by hyperexcitability. Some aspects of the pain associated with inflammatory and functional disorders of the gut may be explained by sensitization of visceral afferents, recruitment of silent nociceptors, central summation of noxious input, and central hyperexcitability. These mechanisms are usually reversible. 1 figure and 35 references. • Polymyositis: An Inflammatory Muscle Disease Source: Mayo Clinic Health Letter. 22(3): 6. March 2004. Contact: Available from Mayo Foundation for Medical Education and Research. 200 First St. SW, Rochester, MN 55905. Summary: This newsletter article provides information on polymyositis and dermatomyositis, two inflammatory muscle diseases (or myopathies) that cause muscle weakness and pain. Symptoms are gradual and include swallowing difficulties and mild muscle pain or tenderness, in addition to progressive muscle weakness. Dermatomyositis also produces a red or violet skin rash on the face, hands, elbows, knees, eyelids, chest, and back. To diagnose these conditions, doctors use a physical examination to assess muscle strength, a patient history, blood tests that check for elevated enzyme levels indicating muscle inflammation, muscle biopsies, and electromyography to detect electrical current in muscles. Corticosteroids are the initial choice for treatment. Other treatments include immunosuppressive drugs and intravenous immunoglobulin. The article lists other conditions that may cause muscle discomfort. • Pelvic Muscle Rehabilitation Source: Quality Care. 16(3): 1-2. Summer 1998. Contact: Available from National Association for Continence. P.O. Box 8310, Spartanburg, SC 29305-8310. (800) 252-3337 or (864) 579-7900. Fax (864) 579-7902. Summary: This newsletter article reviews the use of pelvic floor muscle exercises (Kegel exercises) to prevent or treat urinary incontinence. The author notes that exercising the muscles of the pelvic floor on a regular basis should be as much a part of a woman's preventive health care routine as an annual Pap smear and monthly breast self examination. Pelvic muscles are frequently damaged during childbirth and sometimes by surgery in the pelvic area (hysterectomy or prolapse surgeries for women and prostatectomy for men). The author describes the purpose of pelvic muscle rehabilitation and then details how the exercises are done. The author notes that some people may only need written directions to undertake these exercises, but some people may need help from a health care professional to locate and exercise the pelvic muscles. Biofeedback, electrical stimulation, and vaginal weights are the most common methods used to help individuals locate and begin to use their pelvic muscles. The author concludes that, whichever method is prescribed, successful pelvic muscle rehabilitation depends on a consistent effort by the individual. 1 figure.

Patient Resources 327 Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to muscles. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with muscles. 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 muscles. 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 “muscles” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “muscles”. 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 “muscles” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months.

328 Muscles 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 “muscles” (or a synonym) into the search box, and click “Submit Query.”

329 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.24 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 24 Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

330 Muscles 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)25: • 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://www- med.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.stmarys- ca.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/ 25 Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

Finding Medical Libraries 331 • 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 Library- Shreveport, 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/

332 Muscles • Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html • Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp • Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp • Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/ • Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html • Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm • Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp • Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/ • Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html • Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/ • Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm • Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/ • Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html • Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm • Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330 • Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula) • National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html • National: National Network of Libraries of Medicine (National Library of Medicine) - provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/ • National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

Finding Medical Libraries 333 • 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/

334 Muscles • 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

335 ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: • ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html • MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp • Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/ • Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html • On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/ • Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp • Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). The NIH suggests the following Web sites in the ADAM Medical Encyclopedia when searching for information on muscles: • Basic Guidelines for Muscles Muscle aches Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003178.htm Muscle atrophy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003188.htm Muscle biopsy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003924.htm Muscle function loss Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003190.htm Muscle spasmsor cramps Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003193.htm Muscle strain treatment Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002116.htm

336 Muscles • Signs & Symptoms for Muscles Anxiety Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003211.htm Arthralgia Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003261.htm Atrophy (loss of muscle mass) Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003188.htm Bruising Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003235.htm Contracture Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003185.htm Decreased muscle tone Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003298.htm Diarrhea Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003126.htm Excessive sweating Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003218.htm Excessive urine volume Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003146.htm Fasciculations Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003296.htm Fatigue Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003088.htm Fever Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003090.htm General ill feeling Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003089.htm Joint pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003261.htm Loss of sensation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003206.htm Malaise Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003089.htm Muscle Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003193.htm

Online Glossaries 337 Muscle contractures Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003193.htm Muscle spasms Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003193.htm Muscle strain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003193.htm Muscle twitching Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003296.htm Numbness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003206.htm Stress Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003211.htm Swelling Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003103.htm Tension Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003211.htm Tingling Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003206.htm Vomiting Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm Weakness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003174.htm • Diagnostics and Tests for Muscles Biopsy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003416.htm Blood differential Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003657.htm Blood flow studies Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003442.htm CBC Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003642.htm CT Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003330.htm

338 Muscles CT scan of the head Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003786.htm Electromyography Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003929.htm EMG Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003929.htm Extremity angiography Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003772.htm Extremity arteriography Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003772.htm Muscle biopsy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003924.htm Myelography Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003807.htm Myopathic changes Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001220.htm Nerve conduction studies Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003927.htm Serum calcium Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003477.htm Serum sodium Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003481.htm Spine CT Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003787.htm Spine X-ray Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003806.htm Thyroid function tests Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003444.htm Ultrasound Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003336.htm X-rays of the head Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003802.htm • Background Topics for Muscles Adolescent test or procedure preparation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002054.htm

Online Glossaries 339 Analgesics Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002123.htm Antibody Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002223.htm Benign Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002236.htm Bleeding Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000045.htm Burns Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000030.htm Chronic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002312.htm Exercise Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001941.htm Fracture Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000001.htm Fractures Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000001.htm Infant test or procedure preparation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002055.htm Intravenous Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002383.htm Necrosis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002266.htm Pain medications Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002123.htm Pain relievers Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002123.htm Peripheral Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002273.htm Physical examination Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002274.htm Preschooler test or procedure preparation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002057.htm

340 Muscles Relieved by Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002288.htm Schoolage test or procedure preparation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002058.htm Shellfish Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002851.htm Splints Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000040.htm Sprains Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000041.htm Strains - first aid Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000042.htm Toddler test or procedure preparation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002056.htm Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: • Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical • MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html • Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/ • Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

341 MUSCLES DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abduction: Forcible pulling of a limb away from its natural position, a risk in road accidents and disasters; move outwards away from middle line. [NIH] Abductor: A muscle that draws a part away from the median line. [NIH] Aberrant: Wandering or deviating from the usual or normal course. [EU] Abscess: A localized, circumscribed collection of pus. [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] Acclimatization: Adaptation to a new environment or to a change in the old. [NIH] Accommodation: Adjustment, especially that of the eye for various distances. [EU] Acetaminophen: Analgesic antipyretic derivative of acetanilide. It has weak anti- inflammatory properties and is used as a common analgesic, but may cause liver, blood cell, and kidney damage. [NIH] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Acetylcholinesterase: An enzyme that catalyzes the hydrolysis of acetylcholine to choline and acetate. In the CNS, this enzyme plays a role in the function of peripheral neuromuscular junctions. EC 3.1.1.7. [NIH] Acidosis: A pathologic condition resulting from accumulation of acid or depletion of the alkaline reserve (bicarbonate content) in the blood and body tissues, and characterized by an increase in hydrogen ion concentration. [EU] Acoustic: Having to do with sound or hearing. [NIH] Acrylonitrile: A highly poisonous compound used widely in the manufacture of plastics, adhesives and synthetic rubber. [NIH] Actin: Essential component of the cell skeleton. [NIH] Actinin: A protein factor that regulates the length of R-actin. It is chemically similar, but immunochemically distinguishable from actin. [NIH] Action Potentials: The electric response of a nerve or muscle to its stimulation. [NIH] Actomyosin: A protein complex of actin and myosin occurring in muscle. It is the essential contractile substance of muscle. [NIH] Adaptability: Ability to develop some form of tolerance to conditions extremely different

342 Muscles from those under which a living organism evolved. [NIH] Adaptation: 1. The adjustment of an organism to its environment, or the process by which it enhances such fitness. 2. The normal ability of the eye to adjust itself to variations in the intensity of light; the adjustment to such variations. 3. The decline in the frequency of firing of a neuron, particularly of a receptor, under conditions of constant stimulation. 4. In dentistry, (a) the proper fitting of a denture, (b) the degree of proximity and interlocking of restorative material to a tooth preparation, (c) the exact adjustment of bands to teeth. 5. In microbiology, the adjustment of bacterial physiology to a new environment. [EU] Adduction: The rotation of an eye toward the midline (nasally). [NIH] Adductor: A muscle that draws a part toward the median line. [NIH] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adenovirus: A group of viruses that cause respiratory tract and eye infections. Adenoviruses used in gene therapy are altered to carry a specific tumor-fighting gene. [NIH] Adipocytes: Fat-storing cells found mostly in the abdominal cavity and subcutaneous tissue. Fat is usually stored in the form of tryglycerides. [NIH] Adipose Tissue: Connective tissue composed of fat cells lodged in the meshes of areolar tissue. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerobic: In biochemistry, reactions that need oxygen to happen or happen when oxygen is present. [NIH] 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] Aerobic Metabolism: A chemical process in which oxygen is used to make energy from carbohydrates (sugars). Also known as aerobic respiration, oxidative metabolism, or cell respiration. [NIH] Aerobic Respiration: A chemical process in which oxygen is used to make energy from carbohydrates (sugars). Also known as oxidative metabolism, cell respiration, or aerobic metabolism. [NIH] Aeroembolism: Joint pains, respiratory distress, and central nervous system symptoms which may follow decompression after exposure to air or other gas mixture at a pressure