CHAPTER 19 QUALIFIERS (SUBHEADINGS) 19.1 DEFINITION AND PURPOSE 19.1.1 Subheadings provide a convenient method of grouping constantly recurring aspects of a concept. Material on various subjects appears to fall into large natural groups. Studies on organs tend to be about anatomy, physiology, pathology, etc., whereas drug studies tend to cover metabolism, therapeutic use, etc. These natural categories or frequently discussed aspects of a subject or of main headings are grouped under what MeSH calls subheadings or qualifiers. A subheading is attached directly to the main heading which it qualifies, separated from it by a slash ( / ) and spaces in the indexing operation. For form see sections 9.2.2 and 9.2.3. BRAIN / pathol SODIUM / metab COMA / etiol VACCINATION / hist A subheading will always answer the question "What aspect of this main heading is the author writing about or discussing?" 19.1.2 When an indexer has decided upon the main headings which best describe the article, the next step in indexing is to consider the standpoint from which the author treats each subject. This narrowing down of a main heading generally involves indexing one of the subheadings available for the main heading. In this way, if a searcher is not interested in all aspects of a drug, for example, but only in its metabolism, the search need refer only to the subheading /metabolism with the drug, thus eliminating articles indexed under the subheadings /therapeutic use, /toxicity, etc. 19.1.3 It is the responsibility of the indexer to index the article where it most faithfully reflects the slant and meaning of the discussion, first by choosing the correct main headings and second by pinpointing the slant of each main heading in the form of the correct subheading. 19.1.4 Often the article needs more than one subheading on a single main heading. An article on the pathology and metabolism of the liver is indexed as LIVER/pathology and LIVER/metabolism; an article on the diagnosis, complications and therapy of hepatitis is indexed as HEPATITIS/diagnosis, HEPATITIS/complications and HEPATITIS/therapy. The permissible number of subheadings with the same main heading, and the number which may be made IM, is discussed in sections 19.5 and 19.6. 19.1.5 Occasionally the slant of an article does not fit comfortably into the subheadings available to the main heading. In such cases the indexer is not obliged to force the use of a subheading. NO subheading is preferable to a WRONG one or a MISLEADING one. 19.2 ASSIGNMENT OF SUBHEADINGS 19.2.1 There are currently 82 subheadings available for indexing and searching; however, not every subheading makes sense with every MeSH heading. For example, an article can discuss the /ultrastructure of an organ but not of a therapeutic technique, the /pharmacology of a drug but not of an instrument, /drug effects on an organ but not on hospitals, etc. MeSH has therefore limited the subheadings that can be assigned to any given term. This limitation is created by a field known as the AQ field in the MeSH record for each main heading (AQ stands for "allowable qualifiers"). A subheading, or qualifier, cannot be used with any heading unless it is an AQ for that term; any other subheading will be rejected by the computer. While the use of an AQ field in theory allows complete individualization of the allowable subheadings for each MeSH term, in practice it would be impossible for the MeSH Section to evaluate each of the more than 14,000 MeSH heading records to decide which subheadings could apply to each term. Therefore, using the fact that terms are assigned to MeSH tree categories based on their similarities to other MeSH terms in the same tree, MeSH has created arbitrary groupings which contain the AQs most likely to be applicable to terms within that grouping. For example, the general D list of AQs contains the subheadings most likely to apply to Category D terms (chemicals) in general. In addition, subgroupings exist within D; the ENZYMES list more specifically contains AQs for the enzymes within the D8 tree. The subheading /genetics is not allowed with general Category D terms, because most chemicals are not endogenous, but it is allowed with terms from the ENZYMES list. Once subheadings have been assigned generically within these groups, MeSH can "fine-tune" the AQs for individual terms as the need arises. For instance, SNAKE VENOMS is assigned to subcategory D24 only, for which the subheading /enzymology is not an AQ; however, /enzymology is an AQ for SNAKE VENOMS. 19.2.2 Prior to 1990, the system for assigning subheadings to terms was far less flexible. Almost all subheadings were assigned by category only, and there were only approximately 20 possible groupings. Except for a very few terms for which "extended subheadings" were created, if the subheading desired for a given term did not seem reasonable with most other terms from the same category, chances were slim that the subheading would ever be permitted with the category. Now, the subheading need only be added as an AQ to any terms with which it is reasonable. 19.2.3 Since the computer is programmed to accept a subheading with a main heading only if so assigned, a combination of a main heading and a subheading NOT legitimately assigned will be rejected by the computer. The combination must then be corrected and re-input. 19.3 INVALID MAIN HEADING/SUBHEADING COMBINATIONS 19.3.1 There are many MAIN HEADING/subheading combinations which are invalid because MeSH has provided a specific pre-coordinated term for the combination; if an indexer attempts to index the concept using the MAIN HEADING/subheading it will be rejected. Here are a few examples from the several hundred programmed for rejection: Invalid Correct ARM / injuries ARM INJURIES ACCIDENTS / prevention & control ACCIDENT PREVENTION HISTOLOGY / methods HISTOLOGICAL TECHNIQUES BURNS / chemically induced BURNS, CHEMICAL GLUCOSE / blood BLOOD GLUCOSE Each main heading which has one of these pre-coordinated terms available has been annotated to warn indexers not to index the MAIN HEADING/subheading combination. 19.3.2 MeSH also provides annotations on other forbidden combinations which involve a conflict with established indexing rules. For example, HEART, "the pump," has one set of allowable subheadings and MYOCARDIUM, the heart as tissue, has another set, even though the same array of subheadings is available to both HEART and MYOCARDIUM in the list of Category A qualifiers. 19.3.3 When a subheading is needed with a term for which it is not an AQ, index the main heading without a subheading as IM and use a main heading duplicate or near-duplicate of the subheading as an NIM coordinate, if available (see section 19.7). An article on copying machines is indexed as * COPYING PROCESSES EQUIPMENT AND SUPPLIES since /instrumentation is not an AQ for COPYING PROCESSES. Since main headings tend to have the most commonly used subheadings as AQs, the principle above is not needed very often. 19.4 RULES ON THE USE OF SUBHEADINGS 19.4.1 The section entitled INDEXING OPERATION defines indexing as "the process of assigning to an article the headings from MEDICAL SUBJECT HEADINGS (MeSH) ... which best describe the content and substance as written by the author" (section 4.1). Depth indexing (section 5.1) requires the indexer to use as many headings as are needed to cover major and minor aspects of an article. Section 6, INDEX MEDICUS HEADINGS AND NON-INDEX MEDICUS HEADINGS, discusses the process by which an indexer must decide which headings are the point of the article and will be printed in INDEX MEDICUS (the IM headings) and which are discussed but not the main point and so will be stored in the computer (the NIM headings). The practice of qualifying a main heading with a subheading does not modify the principles of multiple headings given above. The indexer will cover all aspects of any article, using as many headings as needed to describe the article faithfully and making a judgment as to which concepts are to be IM and which NIM. But in addition each main heading must, if possible, be qualified by the correct subheading. 19.4.2 Since the subheading is designed to answer the question, "Given a main heading, what aspects of it is the author discussing?", the indexer must ask and answer this question for every main heading used. If an article is about the metabolism of the liver in arthritis as well as the effect of aspirin therapy on the metabolic function, the indexer must consider the following questions: 1. What aspect of LIVER? 2. What aspect of ARTHRITIS? 3. What aspect of ASPIRIN? The answers in the same order are: 1a. the metabolic aspect of the LIVER 1b. drug effects on the LIVER 2a. the metabolic aspect of ARTHRITIS 2b. the drug therapy of ARTHRITIS 3a. the effect of ASPIRIN 3b. the therapeutic aspect of ASPIRIN The article will then be indexed accordingly, using the appropriate subheadings: 1a. LIVER / metabolism 1b. LIVER / drug effects 2a. ARTHRITIS / metabolism 2b. ARTHRITIS / drug therapy 3a. ASPIRIN / pharmacology 3b. ASPIRIN / therapeutic use 19.5 MULTIPLE SUBHEADINGS AND TREEING OF SUBHEADINGS 19.5.1 Just as MeSH terms are treed according to their relationship with other similar terms, and are arranged hierarchically by their level of specificity, MeSH subheadings may also be treed (see Figure 19.5). Indexers should use the subheading trees in the same way they use the trees for main headings, i.e., at all times indexing the most specific subheading available to cover the concept needed for a given article, but using the trees to group related concepts. For example, if an article is only about the radiography of brain tumors, the correct indexing is BRAIN NEOPLASMS / * radiogr However, if the article is on the radiography, radionuclide imaging, and ultrasonography of the brain neoplasms, the indexer may index each of these concepts NIM but needs a way to group them for the IM; by looking at Figure 19.5 it can be seen that the correct indexing for the IM is BRAIN NEOPLASMS / * diag In addition, if BRAIN NEOPLASMS is just one of many terms to be indexed for the article, or if the article is in a priority 3 journal, the indexer will probably not want to index it with three subheadings at all; by using the subheading trees the decision can be made to cover the 3 related concepts with one subheading BRAIN NEOPLASMS / diag (IM or NIM depending on the article) 19.5.2 Indexers should not use more than three subheadings with any main heading except in very rare circumstances. For any article in which more than three subheadings seem to be needed with one main heading, the indexer should use the subheading trees in an attempt to reduce the number of subheadings required. For example, if an article is about many aspects of a disease and substantively discusses diagnosis, epidemiology, genetic aspects, and therapy, each of these subheadings may be indexed because they have no relationship with one another in the subheading trees. If, however, the article discusses diagnosis, therapy, epidemiology, and mortality of the disease, the last subheading should not be indexed because it is a subset of /epidemiology in the subheading trees. 19.5.3 The following subheadings were not assigned by MeSH to any part of the subheading tree: /class /inj /psychol /drug eff /instrum /rad eff /educ /methods /vet /hist /pathogen SUBHEADING TREES, used to group related concepts. /adv eff /pois /tox /anal /blood /csf /isol /urine /anat /blood supply /cytol /pathol /ultrastruct /embryol /abnorm /innerv /chem /agon /analogs /antag /chem syn /compl /second /cytol /pathol /ultrastruct /diag /pathol /radiogr /radionuclide /ultrasonogr /embryol /abnorm /epidemiol /ethnol /mortal /etiol /chem ind /compl /second /congen /embryol /genet /immunol /microbiol /virol /parasitol /transm /metab /biosyn /blood /csf /defic /enzymol /pharmacokin /urine /microbiol /virol /organ /econ /legis /man /stand /supply /trends /util /pharmacol /admin /adv eff /pois /tox /agon /antag /contra /diag use /pharmacokin /physiol /genet /growth /immunol /metab /biosyn /blood /csf /defic /enzymol /pharmacokin /urine /physiopathol /secret /statist /epidemiol /ethnol /mortal /surg /transpl /ther use /admin /adv eff /contra /pois /ther /diet ther /drug ther /nurs /prev /radiother /rehabil /surg /transpl Figure 19.5 19.6 NUMBER OF SUBHEADINGS IM 19.6.1 In general it is indexing policy to make only one subheading IM with any given term indexed, but the rule is not absolute. If two subheading concepts are both the main point of the article, if they cannot be treed (either one under the other or both under a more general subheading as in Figure 19.5), if they are discussed to the same extent in the article, and if neither is the subject of the journal as a whole, then both may be made IM. However, in most cases there is some reason to choose one of the two to be the IM subheading. Diagnosis and therapy of hemolytic anemia. (This title is from a journal on general internal medicine; diagnosis and therapy are each discussed for approximately 2 pages). Since /diag and /ther are not in the same subheading tree, this article should be indexed as ANEMIA, HEMOLYTIC / * diag / * ther Diagnosis and therapy of hemolytic anemia. (This title is from the same journal, but diagnosis is discussed for the first 3 pages of the article and therapy for just 1 page). The article should be indexed as ANEMIA, HEMOLYTIC / * diag / ther Radiographic and radionuclide imaging of brain disorders. /radiogr and /radionuclide are both treed under /diag in the subheading trees, so the article should be indexed as BRAIN DISEASES / * diag (Either or both /radiogr and /radionuclide may be added NIM depending on the length of the article, how much each aspect is discussed, the number of other concepts to be indexed, priority of the journal, etc.) Pathology and therapy of liver diseases. (This title is from a journal published by a pathology society; pathology and therapy are discussed equally). It should be indexed as LIVER DISEASES / * pathol / ther Pathology and therapy of liver diseases. (This title is from the same pathology society journal, but therapy is discussed for 3 pages, and pathology for just 1 page). It should be indexed as LIVER DISEASES / * ther / pathol 19.6.2 Indexers should not make three or more subheadings IM with the same MeSH heading. If that many subheadings seem to be the main point, are discussed equally, etc., the subheading trees (Figure 19.5) should be consulted; in all likelihood at least two of the subheadings can be treed so that the number of IM subheadings needed is fewer. Diagnosis, ultrasonographic imaging, and epidemiology of kidney diseases. (This title is from a general medicine journal and all 3 concepts are discussed equally). Since /ultrasonogr is treed under /diag in the subheading trees, both concepts can be covered by /*diag; /*diag is thus approximately two-thirds of the article, so the article should be indexed as KIDNEY DISEASES / * diag / epidemiol (/ultrasonogr may also be added NIM depending on the priority of the journal, number of other concepts to cover, etc.) 19.6.3 If, however, there is no relationship among the 3 subheadings in the subheading trees and none of them is the subject of the journal as a whole, then the MeSH term should be made IM "up front" and the subheadings should be indexed NIM. Epidemiology, diagnosis and therapy of toxoplasmosis. * TOXOPLASMOSIS / epidemiol / diag / ther 19.7 MAIN HEADING-SUBHEADING DUPLICATES For many subheadings in MeSH, there are also main headings which are identical or very similar. 19.7.1 Identical main headings: ABNORMALITIES BLOOD CEREBROSPINAL FLUID CHEMISTRY CLASSIFICATION CYTOLOGY DIAGNOSIS DIET THERAPY DRUG THERAPY ECONOMICS EDUCATION EMBRYOLOGY EPIDEMIOLOGY ETHNOLOGY GENETICS HISTORY IMMUNOLOGY METABOLISM METHODS MICROBIOLOGY MORTALITY ORGANIZATION AND ADMINISTRATION PARASITOLOGY PATHOLOGY PHARMACOKINETICS PHARMACOLOGY PHYSIOLOGY POISONING PSYCHOLOGY RADIATION EFFECTS RADIOGRAPHY RADIONUCLIDE IMAGING RADIOTHERAPY REHABILITATION SURGERY TRANSPLANTATION ULTRASONOGRAPHY URINE VIROLOGY 19.7.2 Near-identical main headings: ANATOMY /anat HISTOLOGY /anat BLOOD VESSELS /blood supply JURISPRUDENCE /legis CHEMISTRY, ANALYTICAL /anal LEGISLATION /legis DEFICIENCY DISEASES /defic NERVOUS SYSTEM /innerv DISEASE TRANSMISSION /transm PREVENTIVE MEDICINE /prev DRUG ANTAGONISM /antag STATISTICS /statist ENZYMES /enzymology THERAPEUTICS /ther EQUIPMENT AND SUPPLIES /instrum TOXICOLOGY /tox GROWTH /growth VETERINARY MEDICINE /vet HEALTH MANPOWER /man WOUNDS AND INJURIES /inj 19.7.3 In general the main headings given in both lists above are reserved for general articles only or for articles on the concept as a discipline or a specialty. Surgery in the 21st century. SURGERY / * trends FUTUROLOGY Toxicology for nursing students. TOXICOLOGY / * educ * EDUCATION, NURSING Occurrence of childhood poisoning in the United States. POISONING / * epidemiol UNITED STATES / epidemiol HUMAN (check tag) CHILD (check tag) 19.7.4 Occasionally an indexer needs to cover a concept which cannot be fully indexed by a single MAIN HEADING/subheading coordination; the subheading seems to need a qualifier also. Since our system does not have secondary subheadings, in these cases indexers may add the main heading equivalent of the subheading NIM, qualifying it with the additional subheading needed. Urine cytology in bladder neoplasms. BLADDER NEOPLASMS / * urine URINE / cytol Adverse effects of radiotherapy for breast neoplasms. BREAST NEOPLASMS / * radiother RADIOTHERAPY / adv eff 19.7.5 The additional main heading added for complete indexing must not be made IM, as it is very general. All main headings which have equivalent subheadings are annotated to say "GEN only; prefer /(the subheading)"; for any of these terms to be made IM, the article must deal with the concept in general. When the secondary concept is discussed in general, it may be made IM also, but this will be rare. A new instrument for use in radiotherapy of breast cancer and a study of its use in the treatment of other diseases. BREAST NEOPLASMS / * radiother RADIOTHERAPY / * instrum 19.7.6 If the secondary concept can be covered by applying a second subheading to the original main heading, it should be indexed that way, rather than by adding the general MeSH main heading for the secondary aspect. Surgery of liver abnormalities. LIVER / * abnorm / * surg But: Epidemiology of liver abnormalities. LIVER / * abnorm ABNORMALITIES / epidemiol In these examples, /surg is an AQ for LIVER but /epidemiol is not, so the two articles cannot be indexed in the same way. 19.7.7 If there is another main heading which is more specific than the general subheading equivalent, it should be used rather than the more general term, but still must be made NIM. Methods in pulmonary arteriography. PULMONARY ARTERY / * radiogr ARTERIOGRAPHY / methods (not RADIOGRAPHY / methods) 19.8 SCOPE AND APPLICATION OF SUBHEADINGS The following pages give the subheadings in alphabetical order for easy reference. Each subheading is accompanied by its official MeSH definition and the forms used in indexing and searching. The examples given with each subheading are hypothetical titles which may sometimes appear over-simple to the practiced medical eye; they were intended to illustrate indexing practices only. To avoid distractions, check tags are not always indicated even if appropriate. ALPHABETIC LIST OF SUBHEADINGS WITH ABBREVIATIONS Subheading Form for Form for Searching or Indexing Indexing Online abnormalities.................abnorm......................AB administration & dosage.......admin.......................AD adverse effects...............adv eff.....................AE agonists......................agon........................AG analogs & derivatives.........analogs.....................AA analysis......................anal........................AN anatomy & histology...........anat........................AH antagonists & inhibitors......antag.......................AI biosynthesis..................biosyn......................BI blood.........................blood.......................BL blood supply..................blood supply................BS cerebrospinal fluid...........csf.........................CF chemical synthesis............chem syn....................CS chemically induced............chem ind....................CI chemistry.....................chem........................CH classification................class.......................CL complications.................compl.......................CO congenital....................congen......................CN contraindications.............contra......................CT cytology......................cytol.......................CY deficiency....................defic.......................DF diagnosis.....................diag........................DI diagnostic use................diag use....................DU diet therapy..................diet ther...................DH drug effects..................drug eff....................DE drug therapy..................drug ther...................DT economics.....................econ........................EC education.....................educ........................ED embryology....................embryol.....................EM enzymology....................enzymol.....................EN epidemiology..................epidemiol...................EP ethnology.....................ethnol......................EH etiology......................etiol.......................ET genetics......................genet.......................GE growth & development..........growth......................GD history.......................hist........................HI immunology....................immunol.....................IM injuries......................inj.........................IN innervation...................innerv......................IR instrumentation...............instrum.....................IS isolation & purification......isol........................IP legislation & jurisprudence...legis.......................LJ manpower......................man.........................MA metabolism....................metab.......................ME methods.......................methods.....................MT microbiology..................microbiol...................MI mortality.....................mortal......................MO nursing.......................nurs........................NU organization & administration.organ.......................OG parasitology..................parasitol...................PS pathogenicity.................pathogen....................PY pathology.....................pathol......................PA pharmacokinetics..............pharmacokin.................PK pharmacology..................pharmacol...................PD physiology....................physiol.....................PH physiopathology...............physiopathol................PP poisoning.....................pois........................PO prevention & control..........prev........................PC psychology....................psychol.....................PX radiation effects.............rad eff.....................RE radiography...................radiogr.....................RA radionuclide imaging..........radionuclide................RI radiotherapy..................radiother...................RT rehabilitation................rehabil.....................RH secondary.....................second......................SC secretion.....................secret......................SE standards.....................stand.......................ST statistics & numerical data...statist.....................SN supply & distribution.........supply......................SD surgery.......................surg........................SU therapeutic use...............ther use....................TU therapy.......................ther........................TH toxicity......................tox.........................TO transmission..................transm......................TM transplantation...............transpl.....................TR trends........................trends......................TD ultrasonography...............ultrasonogr.................US ultrastructure................ultrastruct.................UL urine.........................urine.......................UR utilization...................util........................UT veterinary....................vet.........................VE virology......................virol.......................VI Figure 19.8 19.8.1 /abnormalities /AB, /abnorm Used with organs for congenital defects producing changes in the morphology of the organ. It is used also for abnormalities in animals. This subheading is to be used for articles on inborn structural abnormalities only, not for those on abnormal functions or structural anomalies resulting from disease, injuries, etc. Common terms seen in the literature to be indexed with /abnorm are: agenesis, anomaly, aplasia, atresia, deformity, ectopy, hypoplasia, malformation, teratology, duplication (of a single organ), etc. Hepatic agenesis. LIVER / * abnorm Abnormalities of the iliac artery. ILIAC ARTERY / * abnorm Imperforate urethra in a calf. CATTLE / * abnorm URETHRA / * abnorm There are many abnormality headings in Category C16, some of which should be coordinated with a specific organ/abnorm. Check the annotation for each to see if such a coordinate is needed. Jejunal atresia. * INTESTINAL ATRESIA JEJUNUM / * abnorm A drug-induced abnormality of the bile ducts. * ABNORMALITIES, DRUG-INDUCED BILE DUCTS / * abnorm By MeSH definition, /abnorm must be reserved for congenital abnormalities; structural changes in an organ caused by a drug given or disease occurring after birth cannot be indexed as /abnorm. Structural abnormalities of the liver in kidney diseases. LIVER / * pathol KIDNEY DISEASES / * pathol For further discussion of the indexing principles for abnormalities, see sections 21.34 and 23.20+. See also section 19.8.18 for a discussion of the use of the subheading /congenital with disease headings. 19.8.2 /administration & dosage /AD, /admin Used with drugs for dosage forms, routes of administration, frequency and duration of administration, quantity of medication, and the effects of these factors. This subheading needs to be differentiated from /therapeutic use and /pharmacology. Authors may use the word "administration" but not discuss how the drug is administered. In addition, the route of administration or dosage form of the drug may be in the title but not the main point. In these cases, the main point is probably /*ther use or /*pharmacol, with /admin added NIM if at all. Duration of administration of oral ampicillin in the treatment of gonorrhea. AMPICILLIN / * admin / ther use ADMINISTRATION, ORAL GONORRHEA / * drug ther DRUG ADMINISTRATION SCHEDULE Subcutaneous vitamin D injections. VITAMIN D / * admin INJECTIONS, SUBCUTANEOUS A new sustained-release tablet form of meperidine compared with conventional tablets. MEPERIDINE / * admin TABLETS SUSTAINED-RELEASE PREPARATIONS COMPARATIVE STUDY (check tag) But: Effects of cocaine administration on respiration in rats. COCAINE / * pharmacol RESPIRATION / * drug eff Treatment of diabetes with new oral antidiabetics. (This article is about new antidiabetics which, unlike insulin, need not be injected; the point is studying whether the drugs are effective in treatment.) DIABETES MELLITUS / * drug ther ANTIDIABETICS / * ther use (/ admin) (ADMINISTRATION, ORAL) (Concepts in parentheses to be indexed only if discussed.) 19.8.3 /adverse effects /AE, /adv eff Used with drugs, chemicals, or biological agents in accepted dosage - or with physical agents or manufactured products in normal usage - when intended for diagnostic, therapeutic, prophylactic, or anesthetic purposes. It is used also for adverse effects or complications of diagnostic, therapeutic, prophylactic, anesthetic, surgical, or other procedures, but excludes contraindications for which "contraindications" is used. The subheading /adv eff is used for "side effects" or "complications" of a drug, chemical, or procedure. Do not confuse with the following: /contraindications: Used with drugs and procedures for conditions in which the drug should not be given or the procedure performed. /poisoning: Used for the serious condition known as "poisoning", "overdose", or "intoxication". /toxicity: Used only for experimental studies to determine whether a compound is toxic, or under what conditions it becomes toxic. For a full comparison, including examples, of /adv eff, /contra, /pois, and /tox, see section 19.9. 19.8.4 /agonists /AG, /agon Used with chemicals, drugs, and endogenous substances to indicate substances or agents that have affinity for a receptor and intrinsic activity at that receptor. (From Textbook of Pharmacology, 1991, p.16). It is not usually hard to decide that the subheading /agon should be indexed for an article, since the author will use the term "agonist", but the indexer must be careful to use the subheading on the correct chemical. The chemical which is acting as an agonist is indexed with the subheading /pharmacology, while the chemical or receptor to which it is an agonist receives the subheading /agon. Effects on discrimination learning of the low efficacy mu agonist nalbuphine. NALBUPHINE / * pharmacol RECEPTORS, OPIOID, MU / * agon DISCRIMINATION LEARNING / * drug eff Leuprolide, an agonist of luteinizing hormone releasing hormone. LEUPROLIDE / * pharmacol LUTEINIZING HORMONE-RELEASING HORMONE / * agon MeSH contains many pre-coordinated AGONIST terms, which should be used instead of the subheading /agon if available. Effects of serotonin agonists on heart rate. SEROTONIN AGONISTS / * pharmacol HEART RATE / * drug eff Beta-agonists in the treatment of asthma. ASTHMA / * drug ther ADRENERGIC BETA-AGONISTS / * ther use Be very careful to distinguish the word agonist from the word antagonist (covered by the subheading /antagonists & inhibitors, section 19.8.8). 19.8.5 /analogs & derivatives /AA, /analogs Used with drugs and chemicals for substances that share the same parent molecule or have similar electronic structure but differ by the addition or substitution of other atoms or molecules. It is used when the specific chemical heading is not available and no appropriate group heading exists. This subheading has a very restricted use by indexers; only with singular MeSH chemicals for articles on groups of their derivatives. Single analogs must be indexed individually; check MeSH and the Chemical Tool for the specific analog, and if it is not in either place, flag it for the chemical specialists. (They may map the term using /analogs on a MeSH term, but the indexer does not). Synthesis of a series of hydrochlorothiazide derivatives in an attempt to increase pharmacological activity. HYDROCHLOROTHIAZIDE / * analogs / chem syn / pharmacol But: A new analog of hydrochlorothiazide with increased pharmacological activity. (This article is about a specific compound, which although not named in the title will almost certainly be named chemically in the article. The specific chemical should be identified, and if MeSH or the Chemical Tool contains the term, it may be indexed. If not, it must be flagged for the chemical specialists; no attempt should be made by the indexer to index the compound chemically if it is not in MeSH or the Chemical Tool.) The subheading /analogs cannot be used with any plural MeSH chemical term. The plural terminology implies a group of chemicals, so any similar chemicals can be indexed merely by using the plural term. Pharmacology of a new group of morphinan derivatives. MORPHINANS / * pharmacol In addition, /analogs cannot be used as a subheading on terms from the Chemical Tool. Since each of the terms in the Tool maps to a plural MeSH term or as /analogs already, /analogs is illegal. An article on a group of derivatives of a compound in the Chemical Tool should be indexed using only the term for the compound; the computer will automatically map the indexing to a plural term or as /analogs. Pharmacokinetics of a series of sedative pyrithyldione analogs. pyrithyldione / * pharmacokin HYPNOTICS AND SEDATIVES / * pharmacokin (The computer maps the first term to PYRIDONES, a plural term.) 19.8.6 /analysis /AN, /anal Used for the identification or quantitative determination of a substance or its constituents and metabolites; includes the analysis of air, water, or other environmental carrier. It excludes the chemical analysis of tissues, tumors, body fluids, organisms, and plants for which "chemistry" is used. The concept applies to both methodology and results. For analysis of substances in blood, cerebrospinal fluid, and urine the specific subheading designating the fluid is used. The subheading /anal is used with Category D terms (chemicals) for determination of their levels. Do not confuse with the following: /chemistry: Used with Category A and B terms (organs, tissues, microorganisms, parasites and plants) and tumors for their chemical content or composition, and with Category D terms for their chemical composition, structure, characterization and properties. /isolation & purification: Used with Category B terms (microorganisms and parasites) for the obtaining of pure strains or for demonstration of their presence, and with Category D terms for their isolation or purification. /metabolism: Used with Category D terms for changes in levels of endogenous compounds or for changes in the molecular structure of all compounds. Used with Categories A, B, and C for changes in chemical constituents or as a coordinate when /metab or /pharmacokin is used on a Category D term. /pharmacokinetics: Used with exogenous chemicals for studies of their movement through the body. For a full comparison, including examples, of /anal, /chem, /isol, /metab, and /pharmacokin, see section 19.10. 19.8.7 /anatomy & histology /AH, /anat Used with organs, regions, and tissues for normal descriptive anatomy and histology, and for the normal anatomy and structure of animals and plants. /anat is used for articles on either gross anatomy or tissue histology. It should be interpreted as "anatomy or histology"; the "&" does not mean that the article must discuss both. Pancreatic histology. PANCREAS / * anat Morphology of the canine liver. LIVER / * anat DOGS / * anat Structure of the basement membrane. BASEMENT MEMBRANE / * anat Measurement of the uterus during the first trimester ofpregnancy. UTERUS / * anat * PREGNANCY TRIMESTER, FIRST Weight of the human pituitary. PITUITARY GLAND / * anat ORGAN WEIGHT /anat is used to describe normal organs or normal tissue. If a diseased state or pathological condition exists, the proper subheading for a description of the organ or tissue is /pathology instead. Structure of the lung in emphysema. LUNG / * pathol PULMONARY EMPHYSEMA / * pathol The subheading covers organs and tissues but not cells or subcellular structures. For these, use /cytology or /ultrastructure, respectively. Structure of the hepatocyte. LIVER / * cytol Structure of muscle mitochondria. MITOCHONDRIA, MUSCLE / * ultrastruct 19.8.8 /antagonists & inhibitors /AI, /antag Used with chemicals, drugs, and endogenous substances to indicate substances or agents which counteract their biological effects by any mechanism. In using this subheading, the indexer must be careful to pair it with the right drug or chemical; it is often confused. The drug which is doing the antagonizing is indexed with the subheading /pharmacology, while the compound which is being antagonized is indexed with /antag. Reserpine antagonism of acetylcholine. ACETYLCHOLINE / * antag RESERPINE / * pharmacol Chlorpromazine inhibition of norepinephrine. NOREPINEPHRINE / * antag CHLORPROMAZINE / * pharmacol Blockade of the NMDA receptor by MK-801. RECEPTORS, N-METHYL-D-ASPARTATE / * antag MK-801 / * pharmacol The term DRUG ANTAGONISM exists in MeSH, but it should be reserved for general articles only. Drug antagonism as a cause of drug resistance. * DRUG ANTAGONISM * DRUG RESISTANCE Be very careful to distinguish the word antagonist from the word agonist (covered by the subheading /agonists, section 19.8.4). 19.8.9 /biosynthesis /BI, /biosyn Used for the anabolic formation of chemical substances in organisms, in living cells, or by subcellular fractions. Since this subheading is restricted to anabolic formation (constructive metabolic processes) only, it will be used only with naturally-occurring chemicals which are synthesized by the conversion of small molecules to large. The formation of chemicals resulting from the breakdown of other compounds, whether endogenous or exogenous, cannot be indexed with /biosyn on the resultant compound. Amino acid synthesis in the liver in gout. AMINO ACIDS / * biosyn LIVER / * metab GOUT / * metab Streptomycin production by Actinomyces. STREPTOMYCIN / * biosyn ACTINOMYCES / * metab But: Formation of N-demethylcarbachol from carbachol in the liver. N-demethylcarbachol / * metab CARBACHOL / * metab DEALKYLATION (not N-demethylcarbachol / * biosyn) Acetaldehyde is reduced to ethanol by alcohol dehydrogenase. ETHANOL / * metab ACETALDEHYDE / * metab ALCOHOL DEHYDROGENASE / * metab OXIDATION-REDUCTION (not ETHANOL / * biosyn) 19.8.10 /blood /BL, /blood Used for the presence or analysis of substances in the blood; also for examination of, or changes in, the blood in disease states. It excludes serodiagnosis, for which the subheading "diagnosis" is used, and serology, for which "immunology" is used. /blood should be used for in vivo or in vitro studies of substances in the blood, blood cells (including their metabolism), and physical properties of the blood (such as its viscosity, coagulability, etc.). Blood serotonin levels in schizophrenia. SEROTONIN / * blood SCHIZOPHRENIA / * blood Transportation of sodium in erythrocytes from pregnant women. SODIUM / * blood ERYTHROCYTES / * metab PREGNANCY / * blood BIOLOGICAL TRANSPORT / physiol Blood viscosity in hypertension. HYPERTENSION / * blood * BLOOD VISCOSITY Do not use /blood for studies on the hemodynamics of blood, such as its flow, circulation, pressure, etc. These do not usually result from the properties of the fluid itself, but the dynamics of the cardiovascular system which propels it, and thus should be indexed with the subheading /physiology, or /physiopathology in a disease. Blood pressure in labor. LABOR / * physiol * BLOOD PRESSURE Blood volume in migraine. MIGRAINE / * physiopathol * BLOOD VOLUME The subheading /blood is not an AQ for Category D terms normally found in the blood, so /analysis or /metabolism (as appropriate) should be used instead. Changes in blood fibrin levels in liver disease. FIBRIN / * metab LIVER DISEASES / * blood (not FIBRIN / * blood) 19.8.11 /blood supply /BS, /blood supply Used for arterial, capillary, and venous systems of an organ or region whenever the specific heading for the vessel does not exist. It includes blood flow through the organ. When indexing an organ with /*blood supply, add (NIM) the specific type of vessel or flow studied: ARTERIES, MICROCIRCULATION, etc. Since this subheading is used on an organ when a heading for a vessel does not exist in MeSH, do not index a larger vessel from which it arose, even if a term for that larger vessel is available. Vasculature of the kidney. KIDNEY / * blood supply Surgery of the testicular artery. TESTIS / * blood supply ARTERIES / surg (not AORTA, ABDOMINAL / * surg even though the testicular artery arises from the abdominal aorta.) /*blood supply is indexed with REGIONAL BLOOD FLOW (NIM) for studies of the circulation within an organ, unless a specific pre-coordinated CIRCULATION term exists in MeSH. The CIRCULATION terms must only be used for the process of circulation; articles on the anatomy of the vessels within an organ are indexed as the organ / * blood supply. Blood circulation in the stomach. STOMACH / * blood supply REGIONAL BLOOD FLOW Renal circulation. * RENAL CIRCULATION Ultrastructure of capillaries in the liver. LIVER / * blood supply CAPILLARIES / ultrastruct (not * LIVER CIRCULATION) /blood supply is also permitted with tumor site and histologic terms. Vasculature of uterine fibromas. UTERINE NEOPLASMS / * blood supply LEIOMYOMA / * blood supply See also sections 21.4 through 21.6 for a discussion of /blood supply. 19.8.12 /cerebrospinal fluid /CF, /csf Used for the presence or analysis of substances in the cerebrospinal fluid; also for examination of or changes in cerebrospinal fluid in disease states. Cerebrospinal fluid lithium in patients with major depression as related to response to treatment. DEPRESSIVE DISORDER / * csf / * drug ther LITHIUM / * csf / * ther use The cerebrospinal fluid in neurosyphilis. NEUROSYPHILIS / * csf Analysis of cerebrospinal fluid amyloid protein in multiple sclerosis. MULTIPLE SCLEROSIS / * csf CEREBROSPINAL FLUID PROTEINS / * anal AMYLOID / * csf Cerebrospinal fluid leukocyte count in viral meningitis. MENINGITIS, VIRAL / * csf * LEUKOCYTE COUNT CEREBROSPINAL FLUID / cytol 19.8.13 /chemical synthesis /CS, /chem syn Used for the chemical preparation of molecules in vitro. For the formation of chemical substances in organisms, living cells, or subcellular fractions, "biosynthesis" is used. /chem syn must be distinguished from /biosynthesis in that the former will take place in vitro, in the absence of any living biological system; the latter will take place in vivo or in the presence of a living biological system in vitro. When enzymes are used in an industrial context to synthesize chemicals, the subheading used on the resultant chemical should be /biosyn (if clearly an anabolic process) or /metabolism (if a catabolic process or if no indication is given; see section 19.8.9). Do not use the subheading /chem syn for synthesis using enzymes. Pitfalls in the large-scale synthesis of hydrocortisone. HYDROCORTISONE / * chem syn But: Use of immobilized enzymes in the large-scale production of hydrocortisone. ENZYMES, IMMOBILIZED / * metab HYDROCORTISONE / * biosyn Hydrocortisone synthesis in the adrenal cortex. ADRENAL CORTEX / * metab HYDROCORTISONE / * biosyn Distinguish also between the chemical synthesis of a substance and its chemistry or its chemical analysis. An article on the chemical structure of a compound (/chemistry) or on its chemical analysis or determination (/analysis) is not necessarily on its chemical synthesis. The chemistry of hydrocortisone. HYDROCORTISONE / * chem Chemical analysis of hydrocortisone. HYDROCORTISONE / * anal 19.8.14 /chemically induced /CI, /chem ind Used for diseases, syndromes, congenital abnormalities, or symptoms caused by chemical compounds in man or animals. When the subheading /chem ind is indexed with a disease, the subheading used with the drug or chemical involved will be /adverse effects, /poisoning, or /toxicity. Indomethacin-induced peptic ulcer. PEPTIC ULCER / * chem ind INDOMETHACIN / * adv eff Studies in rats to determine if oxazepam causes cortical necrosis in the kidney. OXAZEPAM / * tox KIDNEY CORTEX NECROSIS / * chem ind RATS (check tag) Acute renal failure caused by attempted suicide with haloperidol. HALOPERIDOL / * pois KIDNEY FAILURE, ACUTE / * chem ind * SUICIDE, ATTEMPTED Any disease main heading containing the word TOXIC refers to a chemically- induced or drug-induced disease. The term PSYCHOSES, TOXIC means chemically- induced or drug-induced psychosis; HEPATITIS, TOXIC means chemically- or drug- induced hepatitis. When indexing such a precoordinated TOXIC disease term, it is not possible to use the subheading /chem ind; since it would be redundant, MeSH has not allowed /chem ind as an AQ with any of these terms. Chloroquine-induced psychosis. CHLOROQUINE / * adv eff PSYCHOSES, TOXIC / * etiol not PSYCHOSES, TOXIC / * chem ind) In experimental studies, diseases are often deliberately induced by drugs in order to study some aspect of the disease. In these cases, the drug itself is not being studied, so no subheading is used on it. See section 25.11.2. Metabolism in experimental liver neoplasms induced by 2-acetylaminofluorene. LIVER NEOPLASMS, EXPERIMENTAL / * metab / chem ind 2-ACETYLAMINOFLUORENE 19.8.15 /chemistry /CH, /chem Used with chemicals, biological, and non-biological substances for their composition, structure, characterization, and properties; also used for the chemical composition or content of organs, tissue, tumors, body fluids, organisms, and plants. Excludes chemical analysis and determination of substances for which "analysis" is used; excludes synthesis for which "chemical synthesis" is used; excludes isolation and purification of substances for which "isolation & purification" is used. The subheading /chem is used with Category A and B terms (organs and tissues, microorganisms, parasites and plants) and tumors in Category C4 for their chemical content or composition, and with Category D terms for their chemical characterization, composition, structure, and properties. Do not confuse with the following: /analysis: Used with Category D terms (chemicals) for determination of their levels. /isolation & purification: Used with Category B terms (microorganisms and parasites) for the obtaining of pure strains or for demonstration of their presence, and with Category D terms for their isolation or purification. /metabolism: Used with Category D terms for changes in levels of endogenous compounds or for changes in the molecular structure of all compounds. Used with Categories A, B, and C for changes in chemical constituents or as a coordinate when /metab or /pharmacokin is used on a Category D term. /pharmacokinetics: Used with exogenous chemicals for studies of their movement through the body. For a full comparison, including examples, of /anal, /chem, /isol, /metab, and /pharmacokin, see section 19.10. 19.8.16 /classification /CL, /class Used for taxonomic or other systematic or hierarchical classification systems. This is the most widely assigned subheading; it may be used with terms from all categories except Z (geography). Despite its being an AQ for many terms, however, /class is not used very frequently by most indexers. The titles below are representative of articles indexers may encounter in which /class is appropriate. Taxonomy of vertebrates. VERTEBRATES / * class Characteristics of the various types of anemia. ANEMIA / * class Classification of amino acids. AMINO ACIDS / * class Salmonella serotyping in outbreaks of food poisoning. SALMONELLA FOOD POISONING / * microbiol / * epidemiol SALMONELLA / * class * DISEASE OUTBREAKS SEROTYPING Subtypes of antigen-presenting cells. ANTIGEN-PRESENTING CELLS / * class 19.8.17 /complications /CO, /compl Used with diseases to indicate conditions that co-exist or follow, i.e., co- existing diseases, complications, or sequelae. This subheading is used for two concepts: (1) one disease causing another; and (2) the co-existence of two or more diseases for which no causal relationship can be determined. If disease A causes disease B, this will be indexed as DISEASE A / * compl DISEASE B / * etiol If it is not known whether disease A causes disease B or disease B causes disease A, the article will be indexed as DISEASE A / * compl DISEASE B / * compl Do not confuse /compl with /etiol. Be careful to index /compl on the cause and /etiol on the effect. Remember that it is possible for a headache to be caused by vomiting or for a headache to cause vomiting. The first instance is indexed as HEADACHE / * etiol VOMITING / * compl The second instance is indexed as HEADACHE / * compl VOMITING / * etiol Headache and vomiting may also be co-existent without any discussion of one causing the other, and in that case the article is indexed as HEADACHE / * compl VOMITING / * compl More examples of the use of /compl and /etiol: Complications of trachoma. TRACHOMA / * compl Trachoma complicated by ocular toxoplasmosis. TRACHOMA / * compl TOXOPLASMOSIS, OCULAR / * compl Blindness caused by systemic lupus erythematosus. BLINDNESS / * etiol LUPUS ERYTHEMATOSUS, SYSTEMIC / * compl Systemic lupus erythematosus causing blindness. BLINDNESS / * etiol LUPUS ERYTHEMATOSUS, SYSTEMIC / * compl 19.8.18 /congenital /CN, /congen Used with disease headings to indicate those conditions existing at, and usually before, birth. It excludes morphologic abnormalities and birth injuries, for which "abnormalities" and "injuries" are used. Do not confuse the subheading /congen with /abnormalities or with /genetics. /congen means a disease "existing at birth"; it need not be either a structural abnormality (indexed as the organ/*abnorm) or a familial or hereditary condition (indexed as the disease/*genet). For example, a child may be born with hepatitis (HEPATITIS/*congen) but the hepatitis need have nothing to do with the structure of the liver nor have affected any other member of the family. Authors generally use the term "congenital" in articles where the subheading is appropriate. However, there are some instances in which the indexer should use the subheading /congen even when the author does not. When a disease is not noticed at birth, but is detected in the newborn period and is unlikely to have arisen in the short period after birth, the subheading /congen should be used (for instance, a tumor). Do not check the tag INFANT, NEWBORN for every congenital disease unless the article actually discusses the newborn infant; frequently congenital disease conditions do not come to the attention of physicians until long after the neonatal period. On the other hand, not every disease in a newborn infant is necessarily "congenital"; it may have been acquired several days or more after birth (for example, hospital infections). Do not use the subheading /congen with diseases known to be congenital by definition (e.g., INTESTINAL ATRESIA and EPISPADIAS) or known to be diseases of newborn infants (e.g., JAUNDICE, NEONATAL and HYDROCEPHALUS). MeSH has been annotated to warn the indexer away from the use of /congen with specific headings. In general, Category C16 terms (neonatal diseases and abnormalities) do not have /congen as an AQ. Congenital deafness. DEAFNESS / * congen Congenital cataract. CATARACT / * congen Teratoma in a week-old infant. TERATOMA / * congen INFANT, NEWBORN (check tag) CASE REPORT (check tag) Vesico-ureteral reflux in a newborn caused by urethral valves. VESICO-URETERAL REFLUX / * congen URETHRA / * abnorm INFANT, NEWBORN (check tag) CASE REPORT (check tag) But: Congenitally hypoplastic kidney. KIDNEY / * abnorm (not KIDNEY DISEASES / * congen) Hereditary kidney diseases. KIDNEY DISEASES / * genet (not KIDNEY DISEASES / * congen) 19.8.19 /contraindications /CT, /contra Used with drugs, chemicals, and biological and physical agents in any disease or physical state that might render their use improper, undesirable, or inadvisable. Used also with contraindicated diagnostic, therapeutic, prophylactic, anesthetic, surgical, or other procedures. The subheading /contra is used with drugs and procedures for conditions in which the drug should not be given or the procedure performed. Do not confuse with the following: /adverse effects: Used for "side effects" or "complications" of a drug, chemical, or procedure. /poisoning: Used for the serious condition known as "poisoning", "overdose", or "intoxication". /toxicity: Used only for experimental studies to determine whether a compound is toxic, or under what conditions it becomes toxic. For a full comparison, including examples, of /adv eff, /contra, /pois, and /tox, see section 19.9. 19.8.20 /cytology /CY, /cytol Used for normal cellular morphology of unicellular and multicellular organisms. /cytol is used only for the normal cytology of organs. The cytology of an organ in a disease state is indexed as /pathology. Uterine cytology during menstruation. UTERUS / * cytol * MENSTRUATION But: Uterine cytology in fallopian tube diseases. UTERUS / * pathol FALLOPIAN TUBE DISEASES / * pathol /cytol is used with cell terms at the cellular level. If a subheading is needed for a subcellular element, /ultrastructure is used instead. Structure of the mitochondria in uterine muscle. MITOCHONDRIA, MUSCLE / * ultrastruct MYOMETRIUM / * ultrastruct /cytol is an AQ for some Category B terms (organisms). It is not permitted with vertebrates, because authors do not discuss the cytology of animals but rather of specific organs within an animal. However, /cytol is permitted with invertebrates, bacteria, and fungi. Since viruses are not cellular organisms, /cytol by definition is not allowed with them; /ultrastructure should be used instead. Structure of atypical mycobacteria. MYCOBACTERIUM, ATYPICAL / * cytol Insect cytology. INSECTS / * cytol Protozoan morphology. PROTOZOA / * cytol But: Cytology of the dog pancreas. PANCREAS / * cytol DOGS / * anat (not DOGS / * cytol) Structure of the poliovirus. POLIOVIRUS / * ultrastruct (not POLIOVIRUS / * cytol) 19.8.21 /deficiency /DF, /defic Used with endogenous and exogenous substances which are absent or in diminished amount relative to the normal requirement of an organism or a biologic system. The key to the correct use of this subheading lies in the definition: "the normal requirement." /defic is only permitted with compounds which are normally required by the body, such as nutrients or enzymes. An article on a patient resistant to the analgesic effects of aspirin because of an inadequate dose cannot be indexed ASPIRIN/*defic. Urea excretion in essential amino acid deficiency. UREA / * urine AMINO ACIDS, ESSENTIAL / * defic Pyruvate kinase deficiency in hemolytic anemia. PYRUVATE KINASE / * defic ANEMIA, HEMOLYTIC / * enzymol MeSH has provided many pre-coordinated terms containing the word DEFICIENCY for common deficiency diseases (VITAMIN A DEFICIENCY, etc.). Check before indexing any compound with the subheading /defic to see if such a term exists. Effect of protein deficiency on the metabolism of warfarin. PROTEIN DEFICIENCY / * metab WARFARIN / * metab Although the MeSH definition refers only to the "normal requirement of an organism", restrict the use of /defic to higher organisms. Do not use it for articles on culturing microorganisms in "deficient" media; use /physiology or /metabolism on the "deficient" compound instead. Growth of Salmonella in leucine-deficient media. (Author is studying leucine's role in the growth of Salmonella by omitting it from the culture media to see if growth stops.) SALMONELLA / * growth LEUCINE / * physiol CULTURE MEDIA (not LEUCINE / * defic) For a further discussion of the indexing of /defic and various DEFICIENCY DISEASES, see section 23.25+. 19.8.22 /diagnosis /DI, /diag Used with diseases for all aspects of diagnosis, including examination, differential diagnosis, and prognosis; excludes mass screening for which "prevention & control" is used. Excludes radiographic diagnosis for which "radiography" is used; excludes scintigraphic diagnosis for which "radionuclide imaging" is used; excludes ultrasonic diagnosis for which "ultrasonography" is used. With the exception of checking for one of the specific diagnostic subheadings listed above and/or indented under /diag in the subheading trees (Figure 19.5), this subheading should pose few problems for an indexer, as the author usually uses the word "diagnosis". Diagnosis of gout. GOUT / * diag Differential diagnosis of gout. GOUT / * diag DIAGNOSIS, DIFFERENTIAL Gout simulating arthritis. GOUT / * diag ARTHRITIS / * diag DIAGNOSIS, DIFFERENTIAL Arthritis simulating gout. ARTHRITIS / * diag GOUT / * diag DIAGNOSIS, DIFFERENTIAL Electroencephalographic diagnosis of epilepsy. EPILEPSY / * diag * ELECTROENCEPHALOGRAPHY But: Diagnosis of liver neoplasms by needle biopsy of the liver. LIVER NEOPLASMS /* pathol LIVER / * pathol BIOPSY, NEEDLE Use of ultrasonography in diagnosing liver abscess. LIVER ABSCESS / * ultrasonogr For a discussion of diagnostic techniques, see 26.4+ through 26.14. 19.8.23 /diagnostic use /DU, /diag use Used with chemical compounds, drugs, and physical agents when these substances are used for studies of clinical function of an organ, or for the diagnosis of human or animal diseases. /diag use is indexed on exogenous chemicals administered to perform various function tests, as contrast media, or as tracers. Diatrizoate in renal arteriography. DIATRIZOATE / * diag use RENAL ARTERY / * radiogr Indocyanine green in liver function studies. * LIVER FUNCTION TESTS INDOCYANINE GREEN / * diag use /diag use may also be used with physical agents. Cold effects on blood flow to the fingers in the diagnosis of Raynaud's disease. COLD / * diag use RAYNAUD'S DISEASE / * diag FINGERS / * blood supply REGIONAL BLOOD FLOW / physiol Save /diag use for administered compounds; stains, monoclonal antibodies, etc. used ex vivo should be indexed with no subheading. Methylene blue staining of inclusion bodies in the pathologic diagnosis of cytomegalovirus infection. * METHYLENE BLUE INCLUSION BODIES, VIRAL / * ultrastruct CYTOMEGALIC INCLUSION DISEASE / * pathol /diag use cannot be used with an endogenous chemical when its levels are measured to diagnose a disease; the subheading is reserved for exogenous compounds. However, either BIOLOGICAL MARKERS (NIM) or TUMOR MARKERS, BIOLOGICAL (IM) may be added in such a study. Beta-HCG blood levels in the detection of ectopic pregnancy. BETA HCG / * blood PREGNANCY, ECTOPIC / * diag BIOLOGICAL MARKERS / blood 19.8.24 /diet therapy /DH, /diet ther Used with disease headings for dietary and nutritional management of the disease. The concept does not include vitamin or mineral supplements, for which "drug therapy" may be used. This subheading is relatively easy to use, because the dietary aspect is usually obvious. However, as indicated by the MeSH definition, vitamin and mineral supplements should be indexed as /drug therapy, not /diet ther. Also, tube "feeding" should be indexed as /therapy, not /diet ther. Peptic ulcer diets. PEPTIC ULCER / * diet ther An easily absorbed protein diet for malabsorption syndromes. MALABSORPTION SYNDROMES / * diet ther DIETARY PROTEINS / * admin / * pharmacokin * INTESTINAL ABSORPTION But: Vitamin A supplements in the treatment of vitamin A deficiency. VITAMIN A / * ther use VITAMIN A DEFICIENCY / * drug ther Enteral feeding in patients with Crohn's disease. CROHN DISEASE / * ther * ENTERAL FEEDING 19.8.25 /drug effects /DE, /drug eff Used with organs, regions, tissues, or organisms and physiological and psychological processes for the effects of drugs and chemicals. When using this subheading on an organ, organism, physiological or psychological term, the subheading used on the drug or chemical producing the effect will usually be /pharmacology. Indexers should have no problem in indexing the /drug eff--/pharmacol coordination. Occasionally, one of the subheadings indented under /pharmacol in the Subheading Trees (Figure 19.5) will be the coordination for /drug eff. Effect of penicillin G on the heart. HEART / * drug eff PENICILLIN G / * pharmacol Effect of penicillin G on the fetus. FETUS / * drug eff PENICILLIN G / * pharmacol Response of Treponema pallidum to penicillin G. TREPONEMA PALLIDUM / * drug eff PENICILLIN G / * pharmacol Effect of promazine on learning. LEARNING / * drug eff PROMAZINE / * pharmacol Effects of the amobarbital test on memory and the EEG in epileptic patients. AMOBARBITAL / * diag use MEMORY / * drug eff EEG / * drug eff EPILEPSY / * physiopathol /drug eff is also an AQ for enzymes, proteins, and nucleic acids. Effects of cycloheximide on DNA, C5a peptidase, and proteins in Streptococcus pyogenes. CYCLOHEXIMIDE / * pharmacol STREPTOCOCCUS PYOGENES / * drug eff / genet / enzymol DNA, BACTERIAL / * drug eff BACTERIAL PROTEINS / * drug eff C5a peptidase / * drug eff 19.8.26 /drug therapy /DT, /drug ther Used with disease headings for the treatment of disease by the administration of drugs, chemicals, and antibiotics. For diet therapy and radiotherapy, use specific subheadings. The concept excludes immunotherapy and treatment with biologicals for which "therapy" is used. /drug ther is not restricted to the treatment of disease in humans. It is permitted with veterinary diseases and experimental diseases in animals. If the study concerns the effect of a drug on a disease for the purpose of treating the disease, /drug ther is the correct subheading for clinical or experimental therapy. When using the subheading /drug ther on a disease, the correct coordination will be /therapeutic use on the drug given. Colchicine therapy of gout. GOUT / * drug ther COLCHICINE / * ther use Various trypanocidal drugs in the treatment of bovine trypanosomiasis. TRYPANOSOMIASIS, BOVINE / * drug ther TRYPANOCIDAL AGENTS / * ther use CATTLE (check tag) Therapeutic effects of neomycin in experimental staph infections in mice. NEOMYCIN / * ther use STAPHYLOCOCCAL INFECTIONS / * drug ther MICE (check tag) By definition, /drug ther cannot be used when diseases are treated with so- called "biological products" such as vaccines, sera, antitoxins, etc.; use the subheading /therapy instead. Vaccine therapy of tularemia. TULAREMIA / * ther * VACCINE THERAPY Antitoxin therapy of snake bites. SNAKE BITES / * ther ANTITOXINS / * ther use 19.8.27 /economics /EC, /econ Used for the economic aspects of any subject, as well as for all aspects of financial management. It includes the raising or providing of funds. A method of analyzing the costs of hemophilia therapy. HEMOPHILIA / * econ / * ther COSTS AND COST ANALYSIS / methods The economics of fluoridation. FLUORIDATION / * econ May hospital-shared laundry services qualify for tax exemption? LAUNDRY SERVICE, HOSPITAL / * econ HOSPITAL SHARED SERVICES / * econ * TAXES Salaries in community health nursing. COMMUNITY HEALTH NURSING / * econ * SALARIES AND FRINGE BENEFITS The cost-effectiveness of chloramphenicol in the treatment of typhoid. CHLORAMPHENICOL / * econ / * ther use TYPHOID / * econ / * drug ther COST EFFECTIVENESS These terms have been available in MeSH for many years: ECONOMICS; ECONOMICS, MEDICAL; ECONOMICS, DENTAL; ECONOMICS, HOSPITAL; ECONOMICS, NURSING. Reserve these headings for general articles only; do not use them as coordinates for headings indexable with /econ. The free enterprise system in medicine. * ECONOMICS, MEDICAL Effects of Medicare on U.S. hospitals. * ECONOMICS, HOSPITAL * MEDICARE UNITED STATES Income tax savings for nurses. * ECONOMICS, NURSING * INCOME TAX Although /econ is allowed with many terms, it is sometimes needed with a term for which it is not an AQ. In such a case, index the specific subject (IM) and add ECONOMICS or one of the pre-coordinated ECONOMICS terms such as ECONOMICS, MEDICAL (NIM). The economic implications of the metric system. * METRIC SYSTEM ECONOMICS If the economic aspect needed is a specific concept for which we have a main heading, index the specific subject (IM) and coordinate with the specific economic aspect (IM or NIM depending upon the article); do not add ECONOMICS or ECONOMICS, MEDICAL, etc. Taxing the automobile driver. * AUTOMOBILE DRIVING * TAXES (not ECONOMICS) When indexing an article on the economic aspects of several subjects, use /econ with main headings for which it is an AQ, but add ECONOMICS or one of the pre- coordinated ECONOMICS terms NIM as a coordinate for headings which do not have /econ as an AQ. Economic aspects of efficiency in libraries. LIBRARIES / * econ * EFFICIENCY ECONOMICS 19.8.28 /education /ED, /educ Used for education, training programs, and courses in various fields and disciplines, and for training groups of persons. When indexing a specialty or discipline with the subheading /educ, coordinate it with the specific type of education or education-related concept (e.g., CURRICULUM) from Tree I2. Both are IM. /educ is assumed to be the training of a specialist in that specialty. That is, SOCIOLOGY/*educ is assumed to be the training of sociologists in sociology. For the training of other professionals in sociology, coordinate SOCIOLOGY/*educ with the specific type of professional training (*EDUCATION, MEDICAL, etc.). Training in urology. UROLOGY / * educ Urology in the medical school curriculum. UROLOGY / * educ * EDUCATION, MEDICAL, UNDERGRADUATE * CURRICULUM A refresher course in urology for the pediatrician. UROLOGY / * educ * EDUCATION, MEDICAL, CONTINUING PEDIATRICS / * educ Residencies in obstetrics. OBSTETRICS / * educ * INTERNSHIP AND RESIDENCY Clinical psychology for medical record administrators. MEDICAL RECORD ADMINISTRATORS / * educ PSYCHOLOGY, CLINICAL / * educ Clinical psychology for psychiatrists. PSYCHOLOGY, CLINICAL / * educ PSYCHIATRY / * educ Methods of teaching urology to nursing students. UROLOGY / * educ TEACHING / * methods * EDUCATION, NURSING 19.8.29 /embryology /EM, /embryol Used with organs, regions, and animal headings for embryologic and fetal development. It is used also with diseases for embryologic factors contributing to postnatal disorders. Pancreas embryology. PANCREAS / * embryol Cat embryology. CATS / * embryol Embryonic factors in drug-induced abnormalities. ABNORMALITIES, DRUG-INDUCED / * embryol The embryo in cystic fibrosis. CYSTIC FIBROSIS / * embryol The MeSH definition of /embryol includes the fetus, but since the name of the subheading might imply that it refers only to the embryo, the indexer should add the fetal aspect NIM (if relevant), as a coordinate for /*embryol on a specific organ and/or animal. NOTE: The fetal terms should be reserved for articles on mammals only, and made IM only for studies on the fetus as a whole, not in relation to any specific organ for which the indexer has used /*embryol. Anatomy and development of the human fetus. FETUS / * anat * FETAL DEVELOPMENT HUMAN (check tag) Anatomy of the fetal pancreas. PANCREAS / * embryol FETUS / anat Development of the fetal pancreas. PANCREAS / * embryol FETAL DEVELOPMENT Development of the Japanese quail embryo. COTURNIX / * embryo EMBRYO, NON-MAMMALIAN / growth (not EMBRYO DEVELOPMENT see FETAL DEVELOPMENT) 19.8.30 /enzymology /EN, /enzymol Used with organisms, except vertebrates, and with organs and tissues. It is also used with diseases for enzymes during the course of the disease, but excludes diagnostic enzyme tests, for which "diagnosis" is used. Brain enzymology. BRAIN / * enzymol Determination of aldolase in the brain. BRAIN / * enzymol ALDOLASE / * anal Aldolase activity in the brain in encephalomyelitis. BRAIN / * enzymol ALDOLASE / * metab ENCEPHALOMYELITIS / * enzymol Note the difference in the subheading used on the enzyme in the two examples given above; see section 19.10 for a discussion of the differences between /analysis and /metabolism. Blood catalase activity in alcoholism. ALCOHOLISM / * enzymol CATALASE / * blood Esterase distribution in the spider-mite. MITES / * enzymol ESTERASES / * anal Peroxidase activity of Mycobacterium tuberculosis. MYCOBACTERIUM TUBERCULOSIS / * enzymol PEROXIDASES / * metab Based on the MeSH definition, /enzymol should not be used for diagnostic enzyme tests. See the example below and also sections 25.19.4 and 26.8+ for further discussion of ENZYME TESTS. Urinary amylase in the diagnosis of acute pancreatitis. PANCREATITIS / * diag AMYLASE / * urine * ENZYME TESTS ACUTE DISEASE 19.8.31 /epidemiology /EP, /epidemiol Used with human and veterinary diseases for the distribution of disease, factors which cause disease, and the attributes of disease in defined populations; includes incidence, frequency, prevalence, endemic and epidemic outbreaks; also surveys and estimates of morbidity in geographic areas and in specified populations. Used also with geographical headings for the location of epidemiologic aspects of a disease. Excludes mortality for which "mortality" is used. Note the concepts included under epidemiology above. Many of these are MeSH main headings and are indexed NIM as coordinates for /epidemiol on a disease. These terms are an exception to the rule of indexing only what is discussed. Any mention of an epidemiologic method requires that the method be indexed NIM; see section 26.27+. In addition, when indexing in this field, always consider indexing a geographic term with /epidemiol if relevant; see section 36.6. (The geography may not always be relevant and then should not be added even though it can be ascertained. For example, an incidence study performed in a Wisconsin hospital may not necessarily be about the incidence only in Wisconsin or even in the United States.) NOTE: Geographic terms can never be made IM, so when /epidemiol is used with a geographic term, it cannot be an IM concept. The incidence of pneumonia in Italy. PNEUMONIA / * epidemiol ITALY / epidemiol INCIDENCE Longitudinal studies of pneumonia. PNEUMONIA / * epidemiol LONGITUDINAL STUDIES An outbreak of measles in Maryland. MEASLES / * epidemiol * DISEASE OUTBREAKS MARYLAND / epidemiol Since /ethnology is indented under /epidemiol in the Subheading Trees (Figure 19.5), /epidemiol does not need to be used on a disease for a study of its epidemiology in ethnic or racial groups; use only /ethnology. See next page for example. 19.8.32 /ethnology /EH, /ethnol Used with diseases and selected terms for ethnic, cultural, anthropological, or racial aspects, and with geographic headings to indicate the place of origin of a group of people. This subheading is used with diseases for articles on either ethnic or racial aspects. Do not add /genetics for articles on race unless genetics is also discussed. When /ethnol is indexed, do not add the general terms RACIAL STOCKS or ETHNIC GROUPS, but if a specific ethnic or racial group is discussed, it should be indexed (usually IM). Frequency of Hodgkin's disease in Caucasians. HODGKIN'S DISEASE / * ethnol * CAUCASOID RACE Colon cancer as related to life style in various ethnic groups. COLONIC NEOPLASMS / * ethnol * LIFE STYLE (not ETHNIC GROUPS (IM or NIM)) Since /ethnol is indented under /epidemiology in the Subheading Trees (Figure 19.5), /epidemiology does not need to be used in addition to /ethnol on a disease for a study of its epidemiology in ethnic or racial groups. Occurrence of neuroses in the Aborigines of Australia. NEUROTIC DISORDERS / * ethnol ABORIGINES / * psychol AUSTRALIA / epidemiol (not AUSTRALIA / ethnol (see next page)) But: The frequency of type 2 diabetes in the United States. (Article has a section devoted to its frequency among various native American groups.) DIABETES MELLITUS, TYPE 2 / * epidemiol / ethnol UNITED STATES / epidemiol INDIANS, NORTH AMERICAN / statist Here the main point is /epidemiology in general, with the ethnic aspects merely one section of the article, so both subheadings are needed. /ethnol is also an AQ for various other terms, such as indentions under PREGNANCY and SOCIAL PROBLEMS. If an article seems to be about the ethnic or racial aspects of a concept, check the list of AQs to see if /ethnol is allowed. Labor patterns in Hispanic Americans. LABOR / * ethnol * HISPANIC AMERICANS PREGNANCY (check tag) HUMAN (check tag) FEMALE (check tag) Crime rates among Hispanic Americans. CRIME / * ethnol HISPANIC AMERICANS / * statist UNITED STATES In addition, /ethnol is indexed with a geographic term to mean an ethnic group from that area but living somewhere else. For example, Puerto Ricans as an ethnic group living elsewhere are indexed PUERTO RICO/ethnol. Puerto Ricans living in Puerto Rico are indexed simply as PUERTO RICO. NOTE: Geographic terms can never be made IM, so when /ethnol is used with a geographic term, it cannot be an IM concept even if the point of the article is the ethnic group. Incidence of AIDS in Haitians living in New York City. AIDS / * ethnol NEW YORK CITY / epidemiol HAITI / ethnol INCIDENCE How frequent is colitis in Yemenite Jews in Israel? COLITIS / * ethnol * JEWS YEMEN / ethnol ISRAEL / epidemiol Note the use of /epidemiol and /ethnol on the geographic terms in the two examples above; /ethnol is used only on the area of origin. 19.8.33 /etiology /ET, /etiol Used with diseases for causative agents including microorganisms and includes environmental and social factors and personal habits as contributing factors. It includes pathogenesis. In general, when the subheading /etiol is used, the etiological factor is indexed with the subheading /adverse effects. When one disease causes another, the primary disease is indexed with the subheading /complications, the secondary disease with /etiol. Heat in the etiology of acne. ACNE / * etiol HEAT / * adv eff The pathogenesis of gout. GOUT / * etiol Gout causing iritis. GOUT / * compl IRITIS / * etiol Joint diseases caused by hemochromatosis. HEMOCHROMATOSIS / * compl JOINT DISEASES / * etiol The Subheading Trees (Figure 19.5) give more specific subheadings under /etiol; the specific subheading should be used when appropriate. Fluorides causing acne ACNE / * chem ind FLUORIDES / * adv eff Peptic ulcer caused by Helicobacter pylori infections. * HELICOBACTER PYLORI HELICOBACTER INFECTIONS / * compl PEPTIC ULCER / * microbiol 19.8.34 /genetics /GE, /genet Used for mechanisms of heredity and the genetics of organisms, for the genetic basis of normal and pathologic states, and for the genetic aspects of endogenous chemicals. It includes biochemical and molecular influence on genetic material. This subheading can be used with organisms, endogenous compounds, physiological processes, and diseases, for their genetic and hereditary aspects. A simple method of karyotyping for use with horses. HORSES / * genet KARYOTYPING / * vet / methods Disorders of muscle contraction in hereditary muscular dystrophies. MUSCLE CONTRACTION / * genet MUSCULAR DYSTROPHY / * physiopathol / * genet Esterase polymorphism. ESTERASES / * genet * POLYMORPHISM /genet is also used to index the concept of "familial", meaning "hereditary", disease when no pre-coordinated term exists for the concept. Non-hereditary familial diseases should, however, be indexed with the term FAMILY HEALTH. The hereditary aspects of gout. GOUT / * genet Familial Behcet's disease. BEHCET'S SYNDROME / * genet But: Familial hypercholesterolemia. * HYPERCHOLESTEROLEMIA, FAMILIAL Spread of the common cold in families caused by sharing eating utensils. COMMON COLD / * transm * COOKING AND EATING UTENSILS FAMILY HEALTH EQUIPMENT CONTAMINATION Do not confuse familial or hereditary diseases with congenital diseases. A congenital (occurring at birth) disease may or may not be hereditary, and a hereditary disease may not manifest itself for many years after birth. An article may, of course, discuss the genetics of a congenital disease. Genetic predisposition in congenital hip dislocation. HIP DISLOCATION, CONGENITAL / * genet Do not use /genet merely because a genetic disease is presented in the article unless discussion is devoted to the genetic aspects. The pathology of Turner's syndrome. TURNER'S SYNDROME / * pathol But: Turner's syndrome with ring X chromosomes. TURNER'S SYNDROME / * genet * X CHROMOSOME * RING CHROMOSOMES When an article discusses the genetics of an organism involved in an infection, the subheading /genet is used on the organism, but the correct subheading on the infection is /microbiology, /virology, or /parasitology; save /genet for the genetics of the patient. Genetic characteristics of Salmonella typhi in typhoid patients. SALMONELLA TYPHI / * genet TYPHOID / * microbiol (not TYPHOID / * genet) 19.8.35 /growth & development /GD, /growth Used with microorganisms, plants, and the postnatal period of animals for growth and development. It includes also the postnatal growth or development of organs or anatomical parts. Development of the femur in congenital hip dislocation. HIP DISLOCATION, CONGENITAL / * physiopathol FEMUR / * growth Vertical growth of the nose. NOSE / * growth Growth of Salmonella and the effects of various culture media. SALMONELLA / * growth / * drug eff CULTURE MEDIA / * pharmacol Effect of dietary proteins on the growth of puppies. DOGS / * growth DIETARY PROTEINS / * pharmacol Since this subheading is defined in terms of postnatal growth, prenatal development should be indexed with the subheading /embryology instead. Development of the fetal lung. LUNG / * embryol FETAL DEVELOPMENT 19.8.36 /history /HI, /hist Used for the historical aspects of any subject. It includes brief historical notes but excludes case histories. When the subheading /hist is used, the appropriate historical publication type(s) and check tag(s) must be added. For detailed indexing instructions, see sections 17.42 and 32.15+ (HISTORICAL ARTICLE), 17.13 and 32.16+ ( BIOGRAPHY), and 32.17 (Chronologic Tags). The use of curare by ancient Indian groups in Brazil. CURARE / * hist INDIANS, SOUTH AMERICAN / * hist BRAZIL HISTORICAL ARTICLE (PT) ANCIENT (check tag) If an article is on the history of a topic for which a second subheading is also applicable, make /*hist the only IM subheading. A history of the treatment of epilepsy. EPILEPSY / * hist / ther HISTORICAL ARTICLE (PT) centuries as given in the article /hist should be reserved for terms of actual historical significance. For example, although an article on the discovery of vitamin C can be indexed as VITAMIN C/*hist, an article on the "history" of a drug which is only 15 years old is not really a historical article. The history of the synthesis of zidovudine in our laboratory. ZIDOVUDINE / * chem syn (not ZIDOVUDINE / * hist) If /hist is not an AQ for the MeSH heading to which it applies, merely index the main heading without a subheading and add any historical check tags and publication types which apply. Alchemy in the Middle Ages. * ALCHEMY HISTORICAL ARTICLE (PT) MIDDLE AGES (check tag) 19.8.37 /immunology /IM, /immunol Used for immunologic studies of tissues, organs, microorganisms, fungi, viruses, and animals. It includes immunologic aspects of diseases but not immunologic procedures used for diagnostic, preventive, or therapeutic purposes, for which "diagnosis", "prevention & control", or "therapy" are used. The concept is also used for chemicals as antigens or haptens. When the subheading /immunol is used, it is usually coordinated with one of the many headings in MeSH referring to antigens, antibodies, other immune compounds, and immune activities. Isolation of antigens from Staphylococcus aureus. STAPHYLOCOCCUS AUREUS / * immunol ANTIGENS, BACTERIAL / * isol Antigenic determinants of plasma proteins. BLOOD PROTEINS / * immunol * ANTIGENIC DETERMINANTS Antibody formation in mouse models of gout. GOUT / * immunol ANTIBODY FORMATION MICE (check tag) Localization of Coxsackie A16 viral antigens in various organs of mice. COXSACKIE A VIRUSES / * immunol ANTIGENS, VIRAL / * anal MICE (check tag) Immunochemical techniques are not indexed as /immunol but as /anal, /chem, or /metab (or an indention). But if the compound being studied is an immune compound, /immunol is used on the tissue or disease. Radioimmunoassay of cortisol in blood. CORTISOL / * blood RADIOIMMUNOASSAY Immunoperoxidase demonstration of IgG in the kidney. IGG / * anal KIDNEY / * immunol IMMUNOPEROXIDASE TECHNIQUES By MeSH definition, immunologic diagnosis, therapy, or prevention should be indexed as /diagnosis, /therapy, or /prevention & control, respectively, rather than as /immunol. The serodiagnosis of gout. GOUT / * diag SERODIAGNOSIS Immunotherapy of leukemia. LEUKEMIA / * ther * IMMUNOTHERAPY Frequency of measles vaccination in developing countries. MEASLES / * prev VACCINATION / * util * DEVELOPING COUNTRIES Although mice were merely experimental animals in some of the previous examples, there are occasions in which the type of animal causing the immune reaction, and/or the type of animal in which the response occurs, are the main point of the article. In such cases, index the animal(s) IM with the subheading /*immunol. Antibody formation to porcine versus beef insulin in patients with insulin- dependent diabetes. INSULIN / * immunol INSULIN ANTIBODIES / * biosyn DIABETES MELLITUS, INSULIN-DEPENDENT / * immunol CATTLE / * immunol SWINE / * immunol SPECIES SPECIFICITY ANIMAL (check tag) HUMAN (check tag) COMPARATIVE STUDY (check tag) Do Balb/c mice develop antibodies to HIV-1? HIV-1 / * immunol HIV ANTIBODIES / * biosyn MICE, INBRED BALB C / * immunol ANIMAL (check tag) MICE (check tag) 19.8.38 /injuries /IN, /inj Used with anatomic headings, animals, and sports for wounds and injuries. Excludes cell damage, for which "pathology" is used. The concept of "injury" includes unspecified wounds, blunt or penetrating wounds, contusions, fractures, dislocations, sprains, burns, etc. Many specific injury types are found in Category C21, especially pre-coordinated organ- injuries and bone-fractures terms. Liver injuries. LIVER / * inj Penetrating wounds of the liver. LIVER / * inj * WOUNDS, PENETRATING Surgical treatment of leg fractures. LEG INJURIES / * surg FRACTURES / * surg Radiographic diagnosis of tibial fractures in the horse. TIBIAL FRACTURES / * vet / radiogr HORSES / * inj / radiogr Occurrence of knee and elbow joint injuries in football players. ELBOW JOINT / * inj KNEE INJURIES / * epidemiol FOOTBALL / * inj /inj should be reserved for physical injuries only. Tissue "injuries", for example those caused by a chemical, will probably be indexed as the /pathology of the tissue (and in this case possibly also /drug effects). RADIATION INJURIES should be coordinated with the subheading /radiation effects on the organ affected by the radiation. Radiation injuries of the lung during radiotherapy. RADIOTHERAPY / * adv eff * RADIATION INJURIES LUNG / * rad eff (not LUNG / * inj) 19.8.39 /innervation /IR, /innerv Used with organs, regions, or tissues for their nerve supply. This subheading is to be used when a specific nerve heading is not available in MeSH. Do not attempt to index the nerve by tracing its pathway in a reference book and using the MeSH term for the part of the nervous system from which it arose; merely index the organ with the subheading / innerv. When indexing the subheading /innerv, coordinate IM or NIM with the specific type of innervation (AUTONOMIC NERVOUS SYSTEM, SYMPATHETIC NERVOUS SYSTEM, AFFERENT FIBERS, etc.) if stated by the author. Innervation of the pancreas. PANCREAS / * innerv Parasympathetic innervation of the pancreas. PANCREAS / * innerv * PARASYMPATHETIC NERVOUS SYSTEM Preganglionic fibers of the corpora cavernosa. PENIS / * innerv * AUTONOMIC FIBERS, PREGANGLIONIC The palatine nerve. PALATE / * innerv Anatomy of the gastric nerve. STOMACH / * innerv (not VAGUS NERVE / * anat although the gastric nerve arises from the vagus nerve) For further discussion of the use of /innerv, see section 21.7. 19.8.40 /instrumentation /IS, /instrum Used with diagnostic or therapeutic procedures, analytic techniques, and specialties or disciplines, for the development or modification of apparatus, instruments, or equipment. This subheading refers exclusively to "apparatus, instruments, or equipment." Authors occasionally call a test or questionnaire an "instrument", but that wording should not be covered by /instrum; /methods is probably better. A gas-holding apparatus for use in gas chromatography. CHROMATOGRAPHY, GAS / * instrum A platinum EEG electrode. ELECTROENCEPHALOGRAPHY / * instrum * ELECTRODES * PLATINUM Development of a new film-holder for taking chest x-rays. THORACIC RADIOGRAPHY / * instrum EQUIPMENT DESIGN A new surgical stapler for use in jejunoileal bypass. * SURGICAL STAPLERS JEJUNOILEAL BYPASS / * instrum Sterilization of dairy equipment. DAIRYING / * instrum * STERILIZATION A portable sterilizer for sterilization of dairy equipment. DAIRYING / * instrum STERILIZATION / * instrum But: A psychological instrument for assessing personality. (The "instrument" was a questionnaire, not a piece of equipment.) PERSONALITY ASSESSMENT / * methods QUESTIONNAIRES For a further discussion of equipment and the subheading /instrum, see section 26.24+. 19.8.41 /isolation & purification /IP, /isol Used with bacteria, viruses, fungi, protozoa, and helminths for the obtaining of pure strains or for the demonstration of the presence of or identification of organisms by DNA analyses, immunologic, or other methods, including culture techniques. It is used also with biological substances and chemicals for the isolation and purification of the constituents. The subheading /isol is used with Category B terms (microorganisms and parasites) for obtaining pure strains or for demonstrating their presence, and with Category D terms for their isolation or purification. Do not confuse with the following: /analysis: Used with Category D terms (chemicals) for determination of their levels. /chemistry: Used with Category A and B terms (organs, tissues, microorganisms, parasites, and plants) and tumors for their chemical content or composition, and with Category D terms for their chemical composition, structure, characterization and properties. /metabolism: Used with Category D terms for changes in levels of endogenous compounds or for changes in the molecular structure of all compounds. Used with Categories A, B, and C for changes in chemical constituents or as a coordinate when /metab or /pharmacokin is used on a Category D term. /pharmacokinetics: Used with exogenous chemicals for studies of their movement through the body. For a full comparison, including examples, of /anal, /chem, /isol, /metab, and /pharmacokin, see section 19.10. 19.8.42 /legislation & jurisprudence /LJ, /legis Used for laws, statutes, ordinances, or government regulations, as well as for legal controversy and court decisions. Like all double subheadings (e.g. /prevention & control), /legislation & jurisprudence is used for "legislation OR jurisprudence." Legislation examples: The new Florida Rape Law. RAPE / * legis FLORIDA Nursing home legislation in Maryland. NURSING HOMES / * legis MARYLAND Jurisprudence examples: Expert testimony in sex offenses. SEX OFFENSES / * legis * EXPERT TESTIMONY The discharged hospital employee sues in Virginia Commonwealth Court. PERSONNEL, HOSPITAL / * legis EMPLOYEE GRIEVANCES / * legis VIRGINIA Several of these examples specify the country or the state. It is indexing policy to add a geographic term when indexing laws or court cases; see section 36.7. As with epidemiologic terms which are added whether or not discussed, the geographic terms added for legal or judicial articles need not be discussed but only mentioned. Many general terms are available in MeSH: JURISPRUDENCE; LEGISLATION; LEGISLATION, DENTAL; LEGISLATION, DRUG; LEGISLATION, HOSPITAL; LEGISLATION, MEDICAL; LEGISLATION, NURSING; LEGISLATION, PHARMACY; LEGISLATION, VETERINARY. Reserve these headings for general articles only; for specific topics use the subheading /legis. New dental legislation. * LEGISLATION, DENTAL Pending federal medical legislation. * LEGISLATION, MEDICAL UNITED STATES When an article discusses legal or judicial aspects of a term for which /legis is not an AQ, coordinate the specific subject (IM) with LEGISLATION (NIM) for legislative aspects or with JURISPRUDENCE (NIM) for judicial aspects. Laws on tattooing. * TATTOOING LEGISLATION Court cases involving vaccines. * VACCINES JURISPRUDENCE If the legal or judicial concept needed is a specific aspect for which we have a heading, index the specific subject (IM) and the specific law or jurisprudence aspect (IM) but do not add LEGISLATION or JURISPRUDENCE. Expert testimony in occupational disease cases. * OCCUPATIONAL DISEASES * EXPERT TESTIMONY New legislation on over-the-counter drugs. * OVER-THE-COUNTER DRUGS * LEGISLATION, DRUG In an article on multiple topics, /legis is used with main headings for which it is an AQ, but a LEGISLATION or JURISPRUDENCE term is added for headings with which the subheading cannot be used. The rise in divorce and paternity suits. DIVORCE / * legis * PATERNITY JURISPRUDENCE Laws on architectural accessibility in museums. ARCHITECTURAL ACCESSIBILITY / * legis * MUSEUMS LEGISLATION 19.8.43 /manpower /MA, /man Used with disciplines and programs for the demand, supply, distribution, recruitment, and use of personnel. /man is a statistical concept referring to the number of personnel available in a given field. For example, DENTISTRY/*man means all personnel in the field of dentistry, not necessarily DENTISTS only; manpower in dentistry is also dental technicians, dental hygienists, dental assistants, hospital dental staff, etc. Manpower in medical technology. TECHNOLOGY, MEDICAL / * man Nursing manpower. NURSING / * man Are emergency rooms understaffed? HOSPITAL EMERGENCY SERVICE / * man The shortage of surgeons in Nigeria. SURGERY / * man NIGERIA See also sections 19.8.69 and 35.2.5 for a discussion of the use of /man versus /supply & distribution, which is used with terms from Category M (named groups). 19.8.44 /metabolism /ME, /metab Used with organs, cells and subcellular fractions, organisms and diseases for biochemical changes and metabolism. It is used also with drugs and chemicals for catabolic changes (breakdown of complex molecules into simpler ones). For anabolic processes (conversion of small molecules into large), biosynthesis is used. For enzymology, pharmacokinetics, and secretion use the specific subheadings. The subheading /metab is used with Category D terms for changes in levels of endogenous compounds or for changes in the molecular structure of all compounds. It is used with Categories A, B, and C for changes in chemical constituents or as a coordinate when /metab or /pharmacokin is used on a Category D term. Do not confuse with the following: /analysis: Used with Category D terms (chemicals) for determination of their levels. /chemistry: Used with Category A and B terms (organs, tissues, microorganisms, parasites and plants) and tumors for their chemical content or composition, and with Category D terms for their chemical composition, structure, characterization and properties. /isolation & purification: Used with Category B terms (microorganisms and parasites) for the obtaining of pure strains or for demonstration of their presence, and with Category D terms for their isolation or purification. /pharmacokinetics: Used with exogenous chemicals for studies of their movement through the body. For a full comparison, including examples, of /anal, /chem, /isol, /metab, and /pharmacokin, see section 19.10. 19.8.45 /methods /MT, /methods Used with techniques, procedures, and programs for methods. Do not confuse this subheading with /instrumentation, which refers only to equipment used in various specialties or with various techniques. Many articles discussing methods refer to the instrumentation used and many articles discussing instruments relate them to techniques employing the instruments. Whether /methods, /instrum or both is indexed depends upon the amount of text devoted to the discussion of each. In many articles both the method and the instrumentation are routine and are mentioned merely in passing; in such cases they should not be indexed at all. Enlargement techniques in diagnostic radiology. RADIOGRAPHIC MAGNIFICATION / * methods Hemilaryngectomy. LARYNGECTOMY / * methods Do not use /methods with any MeSH term containing the word "technique" or "techniques". Since the concept of "method" is inherent in the term, MeSH has not allowed /methods as an AQ for any such term. A new enzyme immunoassay technique. * IMMUNOENZYME TECHNIQUES (not IMMUNOENZYME TECHNIQUES / * methods) When the method or technique is important in the article but there is no term to index with the subheading /methods, add the main heading METHODS (NIM). However, remember that a main heading equivalent of a subheading (or another general term) may be added NIM with the subheading /methods (see 19.7.4 and 19.7.7). A method for stripping varicose veins. VARICOSE VEINS / * surg VASCULAR SURGERY / methods not METHODS (NIM)) (not SURGICAL PROCEDURES, OPERATIVE / methods) When indexing an article on the methodologic aspects of several subjects, use /methods with main headings for which it is an AQ, but add METHODS (NIM) as a coordinate for other headings, if there is no general term to be added NIM with the subheading /methods . 19.8.46 /microbiology /MI, /microbiol Used with organs, animals and higher plants and with diseases for microbiologic studies. For parasites, "parasitology" is used; for viruses, "virology" is used. Use this subheading with reference to organisms in Categories B3 (bacteria and rickettsiae) and B5 (fungi). Organisms in Category B1 (the invertebrates) should be indexed as /parasitology, while those in Category B4 (the viruses) should be indexed as /virology. (Since /virol is treed under /microbiol in the Subheading Trees, /microbiol may be used to group the subheadings if viruses are merely studied along with other microorganisms; see Figure 19.5.) Isolation of Mycoplasma from the intestinal tract of a cow. MYCOPLASMA / * isol INTESTINES / * microbiol CATTLE / * microbiol Sputum levels of Mycobacterium tuberculosis in pulmonary tuberculosis. TUBERCULOSIS, PULMONARY / * microbiol SPUTUM / * microbiol MYCOBACTERIUM TUBERCULOSIS / * isol But: Rotavirus gastroenteritis. GASTROENTERITIS / * virol * ROTAVIRUS INFECTIONS The MeSH definition of /microbiol permits its use with disease headings for discussions of microbes in a disease whether the microbe is the causative agent or not. Classification of strains of Staphylococcus in staphylococcal mastitis in cattle. MASTITIS, BOVINE / * microbiol STAPHYLOCOCCAL INFECTIONS / * vet / microbiol STAPHYLOCOCCUS / * class CATTLE (check tag) ANIMAL (check tag) FEMALE (check tag) Demonstration of Pneumocystis carinii in the liver of AIDS patients. AIDS / * microbiol LIVER / * microbiol PNEUMOCYSTIS CARINII / * isol It should be noted that the use of /microbiol is merely a statement of the presence of a microbe; it does not necessarily mean that an infection is present. Although clinically the presence of a microorganism is likely to indicate an infection, remember that articles or discussions concerning a microbe are not necessarily about infections. Demonstration of the presence of Proteus mirabilis in the kidney. PROTEUS MIRABILIS / * isol KIDNEY / * microbiol (not PROTEUS INFECTIONS, KIDNEY DISEASES, or NEPHRITIS unless discussed that way in the article) Do not use /microbiol on an organ to index a microbial infection if there is no pre-coordinated infections term in MeSH; use instead a pre-coordinated organ- diseases term. Bacterial infections of the biliary tract. BILIARY TRACT DISEASES / * microbiol * BACTERIAL INFECTIONS (not BILIARY TRACT / * microbiol) When an article discusses the genetics of a microorganism involved in an infection, use /genet on the organism but /microbiol on the infection. Save /genet with diseases for articles on the genetics of the patients. Genetic variants among strains of Streptococcus group A isolated from recent cases of necrotizing fasciitis. STREPTOCOCCUS GROUP A / * genet / isol * VARIATION (GENETICS) STREPTOCOCCAL INFECTIONS / * microbiol / pathol FASCIITIS / * microbiol / pathol NECROSIS (not STREPTOCOCCAL INFECTIONS / * genet) (not FASCIITIS / * genet) 19.8.47 /mortality /MO, /mortal Used with human and veterinary diseases for mortality statistics. For deaths resulting from various procedures statistically but for a death resulting in a specific case, use FATAL OUTCOME, not /mortality. Since /mortal is statistical, it should be used on diseases and procedures only for studies of the mortality of groups of patients. Mortality in liver cirrhosis. LIVER CIRRHOSIS / * mortal Mortality in spinal anesthesia. ANESTHESIA, SPINAL / * mortal Case reports on individual fatalities (frequently seen with titles such as "A fatal case of ...." or similar expressions) are covered by indexing the term FATAL OUTCOME. This term is to be used only for articles on fatal outcomes in individual cases; the check tag CASE REPORT must be checked. No subheading should be used on the disease or procedure as a coordinate for FATAL OUTCOME (but a subheading may of course be used to cover any other important aspect of the case, such as diagnosis or treatment.) Death of a patient after a routine cholecystectomy. * CHOLECYSTECTOMY FATAL OUTCOME CASE REPORT (check tag) (not: CHOLECYSTECTOMY / * mortal) Needle thoracostomy fails to detect a fatal tension pneumothorax. THORACOSTOMY / * methods PNEUMOTHORAX / * diag FATAL OUTCOME CASE REPORT (check tag) Since /mortal is a subset of /epidemiology in the Subheading Trees (Figure 19.5), the rules used for indexing epidemiologic studies apply to this subheading also. The method used for determining the mortality should be indexed even if merely mentioned. In addition, the geographic location studied should be indexed if relevant, whether or not discussed, and the subheading /epidemiol should be used on the geographic term. Longitudinal studies of mortality in pulmonary hypertension. HYPERTENSION, PULMONARY / * mortal LONGITUDINAL STUDIES Heart attack survival rates in Finland versus France. MYOCARDIAL INFARCTION / * mortal SURVIVAL RATE FINLAND / epidemiol FRANCE / epidemiol COMPARATIVE STUDY (check tag) SURVIVAL RATE and SURVIVAL ANALYSIS are two epidemiologic methods which are frequently used to study mortality. Keep in mind, however, that these may really be measures of treatment effectiveness (especially in diseases such as neoplasms which would be fatal without treatment) and, if so, the subheading /mortal may not be needed even when one of these terms is indexed. A phase II trial of taxol in ovarian neoplasms. (Disease-free and mortality-free survival rates are measured.) OVARIAN NEOPLASMS / * drug ther TAXOL / * ther use SURVIVAL RATE CLINICAL TRIAL, PHASE II (PT) HUMAN (check tag) FEMALE (check tag) (not OVARIAN NEOPLASMS / mortal since this is not an epidemiology study) Although the MeSH definition of /mortal refers only to human and veterinary diseases, the subheading may also be used when indexing an experimental animal study if the author discusses it as a model of the mortality of the disease in humans. A mouse model for disseminated paracoccidioidomycosis: the first animal model with mortality rates similar to those seen in humans. PARACOCCIDIOIDOMYCOSIS / * mortal * DISEASE MODELS, ANIMAL MICE (check tag) ANIMAL (check tag) 19.8.48 /nursing /NU, /nurs Used with diseases for nursing care and techniques in their management. It includes the nursing role in diagnostic, therapeutic, and preventive procedures. The subheading /nurs includes nursing care given by both professional nurses and non-professionals, such as family members. A common coordination with a disease or procedure qualified by /nurs is one of the specific nursing terms in MeSH. Nursing care in gout. GOUT / * nurs Nursing care during cerebral ventriculography. CEREBRAL VENTRICULOGRAPHY / * nurs Private duty nursing in paraplegia. PARAPLEGIA / * nurs * NURSING, PRIVATE DUTY Home nursing in parkinsonism. PARKINSON DISEASE / * nurs * HOME NURSING 19.8.49 /organization & administration /OG, /organ Used for administrative structure and management. The role of transfusion service directors. BLOOD BANKS / * organ * ADMINISTRATIVE PERSONNEL Organization of a facility devoted to the treatment of breast cancer. BREAST NEOPLASMS / * ther CANCER CARE FACILITIES / * organ Scheduling radiology department visits. RADIOLOGY DEPARTMENT, HOSPITAL / * organ * APPOINTMENTS AND SCHEDULES When the concept of organization, administration, or management is needed with a main heading for which /organ is not an AQ, index the main heading (IM) and add ORGANIZATION AND ADMINISTRATION (NIM). The organization of pilot projects. * PILOT PROJECTS ORGANIZATION AND ADMINISTRATION If the organizational aspect is a specific heading available in MeSH, index the subject of the article (IM) and add the heading for the organizational aspect (also IM) but do not add ORGANIZATION AND ADMINISTRATION. Personnel management in transportation fields. * TRANSPORTATION * PERSONNEL MANAGEMENT When indexing an article on the organizational aspects of several subjects, use /organ with main headings for which it is an AQ, but add ORGANIZATION AND ADMINISTRATION as an NIM coordinate for headings which do not have /organ as an AQ. Management of blood banks and organ transplantation programs. BLOOD BANKS / * organ * ORGAN TRANSPLANTATION ORGANIZATION AND ADMINISTRATION 19.8.50 /parasitology /PS, /parasitol Used with animals, higher plants, organs, and diseases for parasitic factors. In diseases, it is not used if the parasitic involvement is implicit in the diagnosis. The subheading /parasitol should be used with organs, diseases, animals and plants for articles on their parasites. The most common parasites we index are helminths and protozoa, but /parasitol should be used for articles on any organism from Category B1 (the invertebrates) discussed as a parasite. The numbers of Giardia in the feces of infected children. GIARDIASIS / * parasitol GIARDIA / * isol FECES / * parasitol Tick infestations of cats. CAT DISEASES / * parasitol TICK INFESTATIONS / * vet As with the subheadings /microbiology and /virology, /parasitol may be used with a disease heading for any discussion of parasites in the disease, whether or not the parasites cause the disease. Also, an article may discuss a parasite in an organ without being about an infection of that organ. Isolation of Dioctophyma in heartworm disease of dogs. DIOCTOPHYMA / * isol HEARTWORM DISEASE / * vet / parasitol DOG DISEASES / * parasitol DOGS (check tag) Demonstration of parasites in the lungs of healthy cats. LUNG / * parasitol CATS / * parasitol (not LUNG DISEASES, PARASITIC / * vet) (not CAT DISEASES / * parasitol) Do not use /parasitol on an organ to index a parasitic infection if there is no precoordinated organ-infections term in MeSH; use instead a pre-coordinated organ-diseases term. Helminth infections of the kidney. * HELMINTHIASIS KIDNEY DISEASES / * parasitol (not KIDNEY / * parasitol) Although /parasitol is an AQ for organisms in Category B1, it is not to be used for articles on them as parasites, but rather for studies of their parasites. Relations of Schistosoma mansoni to its host Biomphalaria. BIOMPHALARIA / * parasitol SCHISTOSOMA MANSONI / * physiol HOST-PARASITE RELATIONS (not SCHISTOSOMA MANSONI / * parasitol) (not SCHISTOSOMIASIS MANSONI / * vet; see section 23.33.9 for parasites in invertebrates) Studies on nematodes in South American cestodes. NEMATODA / * isol CESTODA / * parasitol SOUTH AMERICA When an article discusses the genetics of a parasite involved in a disease, use /genet on the parasite, but /parasitol on the disease; save /genet on diseases for studies of the genetics of the patients. Genes coding for ribosomal proteins in Leishmania infantum isolated from infected patients. LEISHMANIA INFANTUM / * genet / isol RIBOSOMAL PROTEINS / * genet PROTOZOAN PROTEINS / * genet * GENES, PROTOZOAN LEISHMANIASIS, VISCERAL / * parasitol (not LEISHMANIASIS, VISCERAL / * genet) 19.8.51 /pathogenicity /PY, /pathogen Used with microorganisms, viruses, and parasites for studies of their ability to cause disease in man or animals. This subheading should be reserved for discussions of an organisms's ability or inability to cause disease (its "virulence" or "pathogenicity"). The studies may be performed in vitro. Fatal Streptococcal infections caused by a new strain of Streptococcus group A; how has the organism's virulence changed in the last 10 years? STREPTOCOCCAL INFECTIONS / * microbiol / mortal STREPTOCOCCUS GROUP A / * pathogen VIRULENCE Studies to determine if Mycobacterium bovis isolated from cases of bovine tuberculosis is pathogenic to humans. MYCOBACTERIUM BOVIS / * pathogen / isol TUBERCULOSIS, BOVINE / * microbiol CATTLE (check tag) ANIMAL (check tag) HUMAN (check tag) Do not index /pathogen merely because the word "pathogenic" is used to cover the concept that an infection exists in a patient or animal. If there is no discussion of the ability of the organism to cause the infection, all that should be indexed is the organism-infection term. Epidemiology of pathogenic Escherichia coli in Poland. (No discussion of the organism itself, just the infection.) ESCHERICHIA COLI INFECTIONS / * epidemiol POLAND / epidemiol (not ESCHERICHIA COLI / * pathogen) /pathogen should not be used to cover an infection when there is no specific pre-coordinated organism-infection term in MeSH; instead, index the organism IM with no subheading and add the next most specific organism-infection term available in MeSH, also IM. Gardnerella infections. * GARDNERELLA * BACTERIAL INFECTIONS (not GARDNERELLA / * pathogen) 19.8.52 /pathology /PA, /pathol Used for organ, tissue, or cell structure in disease states. The subheading /pathol is used to index deviations from the normal structure of organs, tissues and cells; /anatomy & histology is used for the normal structure of organs and tissues, and /cytology is used for normal cells. The normal and pathological liver cell. LIVER / * cytol LIVER / * pathol Connective tissue pathology. CONNECTIVE TISSUE / * pathol When indexing /pathol on a disease, any organ discussed must also be indexed even if it is the organ affected by the disease; /pathol used on the disease term does not imply any particular organ. Conversely, the indexer must not assume that an organ with the subheading /pathol must be indexed merely because /pathol has been used on a disease of that organ. An author may discuss the general pathology of a disease without emphasizing one organ in particular. See the first and second examples below; even though hepatitis is a liver disease, the liver should be indexed only if it is especially discussed. The pathology of hepatitis. HEPATITIS / * pathol (not LIVER / * pathol) Liver pathology in hepatitis. LIVER / * pathol HEPATITIS / * pathol Kidney pathology in hepatitis. KIDNEY / * pathol HEPATITIS / * pathol Liver pathology in the diagnosis of hepatitis. LIVER / * pathol HEPATITIS / * pathol (not: HEPATITIS / * diag, because of Subheading Trees) /ultrastructure (for the subcellular structure of organs and tissues) is different from /anat and /cytol; it can be used for either normal or pathological states. However, it is not an AQ for Category C terms (except for neoplasms) and therefore the correct coordinate is /pathol on the disease. Submitochondrial particles of the muscle in muscular dystrophy. MUSCULAR DYSTROPHY / * pathol MITOCHONDRIA, MUSCLE / * ultrastruct SUBMITOCHONDRIAL PARTICLES / * ultrastruct Do not use /pathol to index "disease" when MeSH does not provide an organ- diseases term. /pathol refers only to the structure of tissue and is not meant to be a substitute for "disease". Always restrict /pathol to a description of the appearance of an organ, tissue or cell. Diseases of the ciliary body. * CILIARY BODY UVEAL DISEASES (not CILIARY BODY / * pathol) Likewise, authors sometimes use the word "pathology" as a substitute for "disease"; indexers should not use the subheading /pathol in these instances, but save it for studies of structure. Epidemiology of lung pathology in coal miners. * COAL MINING LUNG DISEASES / * epidemiol OCCUPATIONAL DISEASES / * epidemiol (not LUNG / * pathol unless the appearance of the lung is discussed) 19.8.53 /pharmacokinetics /PK, /pharmacokin Used for the mechanism, dynamics and kinetics of exogenous chemical and drug absorption, biotransformation, distribution, release, transport, uptake, and elimination as a function of dosage, extent, and rate of metabolic processes. The subheading /pharmacokin is used with exogenous chemicals for studies of their movement through the body. Do not confuse with the following: /analysis: Used with Category D term (chemicals) for determination of their levels. /chemistry: Used with Category A and B terms (organs, tissues, microorganisms, parasites and plants) and tumors for their chemical content or composition, and with Category D terms for their chemical composition, structure, characterization and properties. /isolation & purification: Used with Category B terms (microorganisms and parasites) for obtaining pure strains or for demonstration of their presence, and with Category D terms for their isolation or purification. /metabolism: Used with Category D terms for changes in levels of endogenous compounds or for changes in the molecular structure of all compounds. Used with Categories A, B, and C for changes in chemical constituents or as a coordinate when /metab or /pharmacokin is used on a Category D term. For a full comparison, including examples, of /anal, /chem, /isol, /metab, and /pharmacokin, see section 19.10. 19.8.54 /pharmacology /PD, /pharmacol Used with drugs and exogenously administered chemical substances for their effects on living tissues and organisms. It includes acceleration and inhibition of physiological and biochemical processes and other pharmacologic mechanisms of action. /pharmacol is used with Category D terms exclusively. The corresponding subheading coordinate is almost always /drug effects on an organ, organism, or physiological or psychological process. Mechanism of action of cephalosporins on Bacillus cereus. BACILLUS CEREUS / * drug eff CEPHALOSPORINS / * pharmacol Effect of mannitol on coronary ultrastructure. MANNITOL / * pharmacol CORONARY VESSELS / * drug eff / * ultrastruct Suppression of lactation by diethylstilbestrol. LACTATION / * drug eff DIETHYLSTILBESTROL / * pharmacol DEPRESSION, CHEMICAL Antagonism of morphine by naloxone. MORPHINE / * antag NALOXONE / * pharmacol Sometimes "The effect of" a Category D term should not be indexed as its /pharmacol. "The effect of" an endogenous substance may be its /physiology; see section 19.8.55. "The effect of" a drug on a disease is probably its /therapeutic use, not /pharmacol unless only about the effects of the drug on some aspect of the disease process. Effect of penicillin on experimental hepatitis in dogs. HEPATITIS, ANIMAL / * drug ther PENICILLINS / * ther use DOGS (check tag) Effect of a single dose of propranolol on heart rate in patients with hypertension. PROPRANOLOL / * pharmacol HEART RATE / * drug eff HYPERTENSION / * physiopathol 19.8.55 /physiology /PH, /physiol Used with organs, tissues, and cells of unicellular and multicellular organisms for normal function. It is used also with biochemical substances, endogenously produced, for their physiologic role. This subheading is restricted to articles on normal function. For disordered function, use /physiopathology; see section 19.8.56. Liver function. LIVER / * physiol Effect of pregnancy on the liver. LIVER / * physiol PREGNANCY / * physiol Changes in cerebral metabolism during mental tasks. BRAIN / * metab MENTAL PROCESSES / * physiol Role of insulin in body weight regulation. BODY WEIGHT / * physiol INSULIN / * physiol Effects of endogenous serotonin in labor. SEROTONIN / * physiol LABOR / * physiol Note that in the last two examples the Category D terms are endogenous compounds which have /physiol as an AQ. Remember that /physiol is to be reserved for the role of the compound in the body. The clue to correct indexing of /physiol with Category D terms will be words like "function of", "physiology of", "role in", "endogenous", etc. Substances for which /physiol is an AQ can also be used as drugs and can affect physiological processes. In these cases, the drug should be indexed with /pharmacology (not /physiol) and the physiological process should be indexed with /drug effects; see section 19.8.54. Effects of intravenous serotonin on heart rate in labor. SEROTONIN / * pharmacol / admin HEART RATE / * drug eff LABOR / * drug eff / physiol INJECTIONS, INTRAVENOUS 19.8.56 /physiopathology /PP, /physiopathol Used with organs and diseases for disordered function in disease states. This subheading is used with an organ for its disordered function in a disease, or with a disease for disordered physiology caused by the disease. Liver function in hepatitis. LIVER / * physiopathol HEPATITIS / * physiopathol Heart function in normal pregnancy and pregnancy in patients with mitral valve prolapse. HEART / * physiol HEART / * physiopathol PREGNANCY / * physiol PREGN COMPL CARDIOVASCULAR / * physiopathol MITRAL VALVE PROLAPSE / * physiopathol Brain function in schizophrenia. SCHIZOPHRENIA / * physiopathol BRAIN / * physiopathol The normal function of an organ in an unrelated disease is indexed as the /physiology of the organ. Normal lung function in heart diseases. LUNG / * physiol HEART DISEASES / * physiopathol Occasionally an author uses a phrase such as "liver physiopathology" in a title. In such instances, the text will determine whether the correct indexing is LIVER/*physiopathol or LIVER DISEASES. Do not use /physiopathol on an organ to cover "disease" in the absence of a pre- coordinated organ-diseases heading; save it for studies of disordered function. Diseases of the cystic duct. * CYSTIC DUCT BILE DUCT DISEASES (not CYSTIC DUCT / * physiopathol) 19.8.57 /poisoning /PO, /pois Used with drugs, chemicals, and industrial materials for human or animal poisoning, acute or chronic, whether the poisoning is accidental, occupational, suicidal, by medication error, or by environmental exposure. The subheading /pois is used for the serious condition known as "poisoning", "overdose", or "intoxication". Do not confuse with the following: /adverse effects: Used for "side effects" or "complications" of a drug, chemical, or procedure. /contraindications: Used with drugs and procedures for conditions in which the drug should not be given or the procedure performed. /toxicity: Used only for experimental studies to determine whether a compound is toxic, or under what conditions it becomes toxic. For a full comparison, including examples, of /adv eff, /contra, /pois, and /tox, see section 19.9. 19.8.58 /prevention & control /PC, /prev Used with disease headings for increasing human or animal resistance against disease, (e.g., immunization), for control of transmission agents, for prevention and control of environmental hazards, or for prevention and control of social factors leading to disease. It includes preventive measures in individual cases. This subheading, like other two-part subheadings (e.g., /legislation & jurisprudence), may be used for articles on either prevention or control of diseases and environmental hazards; an article does not need to discuss both prevention and control. The first half of the subheading rarely poses difficulties for indexers, who realize that /prev should be indexed not only when the word "prevention" is used, but also when words or phrases like "reducing the risk of", "prophylaxis", "immunization against", etc. appear. As can be seen from the scope note above, /prev may be used for case reports discussing prevention. Methods used to reduce the high occurrence of syphilis. SYPHILIS / * prev Prevention of measles by passive immunization. MEASLES / * prev * IMMUNIZATION, PASSIVE Prevention of air and water pollution. AIR POLLUTION / * prev WATER POLLUTION / * prev Ergotamine prevention of migraine recurrence in a 46-year-old woman. MIGRAINE / * prev ERGOTAMINE / * ther use RECURRENCE HUMAN (check tag) MID AGE (check tag) FEMALE (check tag) CASE REPORT (check tag) Articles on the "control" of disease in a public health context should also be indexed with the subheading /prev. The subheading should not, however, be used for "control" of disease in individual patients. In most cases, "control" of a physiologic dysfunction in a patient with a disease is part of the overall management of that disease, and therefore /therapy or a more specific therapeutic subheading should be used rather than /prev. Controlling malaria by spraying for mosquitoes. MALARIA / * prev MOSQUITO CONTROL / * methods But: Use of an insulin infusion system to control blood glucose in a patient with type 1 diabetes. * INSULIN INFUSION SYSTEMS BLOOD GLUCOSE / * drug eff DIABETES MELLITUS, TYPE 1 / * drug ther / blood HUMAN (check tag) CASE REPORT (check tag) (not: DIABETES MELLITUS, TYPE 1 / * prev) 19.8.59 /psychology /PX, /psychol Used with non-psychiatric diseases, techniques, and named groups for psychologic, psychiatric, psychosomatic, psychosocial, behavioral, and emotional aspects, and with psychiatric disease for psychologic aspects; used also with animal terms for animal behavior and psychology. /psychol may be used for articles on the psychological aspects of diseases, procedures, groups of people, and higher animals. It may also be used instead of /complications or /adverse effects for psychological diseases resulting from other diseases or procedures. The ulcer personality. PEPTIC ULCER / * psychol * PERSONALITY Alcoholic memory disorders. ALCOHOLISM / * psychol MEMORY DISORDERS / * etiol Aggressiveness of pit bulldogs. DOGS / * psychol * AGGRESSION Psychological adaptation of the patient to colostomy. COLOSTOMY / * psychol * ADAPTATION, PSYCHOLOGICAL Post-mastectomy depression. DEPRESSION / * etiol MASTECTOMY / * psychol If an article is on the psychology of a subject for which /psychol is not an AQ, index the subject (IM) and add PSYCHOLOGY (NIM), or any specific psychological term (IM). The psychological response to long periods of rain. * RAIN PSYCHOLOGY Motivation to use seat belts. * SEAT BELTS * MOTIVATION 19.8.60 /radiation effects /RE, /rad eff Used for effects of ionizing and nonionizing radiation upon living organisms, organs and tissues, and their constituents, and upon physiologic processes. It includes the effect of irradiation on drugs and chemicals. When indexing /rad eff, assume it refers to x-rays unless otherwise specified and do not add X-RAYS as a coordinate unless the x-rays are compared with other radiation. Except for x-rays, always specify the type of ray if given (a term indented under RADIATION in Category H or RADIOISOTOPES in Category D1), making it IM if it is the point of the article. Do not index RADIATION, IONIZING or RADIATION, NON-IONIZING unless the article is very general and the specific type of ray is not specified; when one of these terms is indexed, it will seldom be IM. Effect of x-rays on the pancreas. PANCREAS / * rad eff Effect of ultraviolet rays on Salmonella. SALMONELLA / * rad eff * ULTRAVIOLET RAYS Effect of ionizing radiation on plants. PLANTS / * rad eff RADIATION, IONIZING Radiation injuries to the ovary. OVARY / * rad eff * RADIATION INJURIES Stability of aspirin stored in light-permeable versus light- resistant containers. ASPIRIN / * rad eff * LIGHT * DRUG CONTAINERS AND CLOSURES DRUG STABILITY COMPARATIVE STUDY (check tag) For a further discussion of the indexing of radiation and the use of /rad eff, see sections 28.11 through 28.13. 19.8.61 /radiography /RA, /radiogr Used with organs, regions, and diseases for x-ray examinations. It does not include radionuclide imaging for which "radionuclide imaging" is used. /radiogr is used for articles on the "x-ray image of organs" and "the x-ray diagnosis of disease". Radioisotope scanning does not go here; use instead the subheading /radionuclide imaging. X-raying the pancreas. PANCREAS / * radiogr Radiography of the lung. LUNG / * radiogr X-ray diagnosis of pulmonary tuberculosis. TUBERCULOSIS, PULMONARY / * radiogr MeSH contains terms for many specific types of radiographic studies; some of these terms should be indexed as coordinations for /radiogr on an organ and/or disease, while others are pre-coordinated terms for the radiography of a specific organ. Every organ for which a pre-coordinated radiography term is available has a warning in MeSH not to index the organ/radiogr but rather the pre-coordinated term. Cholecystographic diagnosis of cholelithiasis. CHOLELITHIASIS / * radiogr * CHOLECYSTOGRAPHY Cineradiography of the lung in patients with emphysema. LUNG / * radiogr * CINERADIOGRAPHY PULMONARY EMPHYSEMA / * radiogr Computed tomography of the brain in the diagnosis of tumors. BRAIN / * radiogr * TOMOGRAPHY, X-RAY COMPUTED BRAIN NEOPLASMS / * radiogr Radiography of the cerebral arteries. * CEREBRAL ANGIOGRAPHY (not CEREBRAL ARTERIES / * radiogr) 19.8.62 /radionuclide imaging /RI, /radionuclide Used for radionuclide imaging of any anatomical structure, or for the diagnosis of disease. /radionuclide is used for studies in which an image of an organ is obtained with radioisotopes; the radioisotope used in performing the scan is indexed with the subheading /diagnostic use. Common concepts which should be indexed as /radionuclide include "scintigraphy" and "isotope scanning". When x-rays are used to obtain the image of the organ, /radiography should be indexed instead; "CAT scans" are performed with x-rays and should therefore be indexed as /radiogr. Brain scintigraphy. BRAIN / * radionuclide Thallium-201 for myocardial imaging. HEART / * radionuclide THALLIUM RADIOISOTOPES / * diag use Early radionuclide diagnosis of acute osteomyelitis. OSTEOMYELITIS / * radionuclide ACUTE DISEASE TIME FACTORS Radioisotopes used in ORL diagnostic scans. OTORHINOLARYNGOLOGICAL DISEASES / * radionuclide RADIOISOTOPES / * diag use Radionuclide cystography in detecting vesicoureteral reflux. BLADDER / * radionuclide VESICO-URETERAL REFLUX / * radionuclide Comparison of x-rays and scanning in bone tumors. BONE NEOPLASMS / * radiogr / * radionuclide COMPARATIVE STUDY (check tag) 19.8.63 /radiotherapy /RT, /radiother Used with disease headings for the therapeutic use of ionizing and nonionizing radiation. It includes the use of radioisotope therapy. While /radiography is restricted to x-ray imaging techniques, /radiother includes the therapeutic use of other radiations such as radioisotopes. However, /radiother will be presumed to be x-ray therapy unless otherwise specified, and X-RAY THERAPY should be indexed only when compared with other types of radiotherapy. When any other type of radiotherapy is studied, it should be added as an IM coordinate for /*radiother. /radiother is not restricted to the treatment of human diseases. It is permitted for the treatment of disease in experimental or veterinary animals. Radiotherapy of skin cancer. SKIN NEOPLASMS / * radiother X-ray therapy of skin cancer. SKIN NEOPLASMS / * radiother Cobalt teletherapy of brain tumors. BRAIN NEOPLASMS / * radiother COBALT RADIOISOTOPES / * ther use * RADIOISOTOPE TELETHERAPY Ultraviolet therapy of eczema. ECZEMA / * radiother * ULTRAVIOLET THERAPY Radiotherapy of experimental skin neoplasms in the rat. SKIN NEOPLASMS / * radiother RATS (check tag) 19.8.64 /rehabilitation /RH, /rehabil Used with diseases and surgical procedures for restoration of function of the individual. /rehabil is used with diseases and surgical procedures for articles where the intent is to get the patient out of bed and into the normal activities of life whether cured or not. The subheading is used for physical procedures only, such as exercise therapy, splinting, use of self-help devices, etc.; restoration of function by surgical means should be indexed as /surgery instead. Braces to assist walking after leg fractures. FRACTURES / * rehabil LEG INJURIES / * rehabil * BRACES Rehabilitation after coronary bypass. CORONARY ARTERY BYPASS / * rehabil Early mobilization after spinal injuries. SPINAL INJURIES / * rehabil * EARLY MOBILIZATION Vocational rehabilitation for psychiatric patients. MENTAL DISORDERS / * rehabil * REHABILITATION, VOCATIONAL But: Reconstruction of the breast after mastectomy. * MASTECTOMY * BREAST RECONSTRUCTION REOPERATION (not MASTECTOMY / * rehabil) 19.8.65 /secondary /SC, /second Used with neoplasms to indicate the secondary location to which the neoplastic process has metastasized. Metastasis means the movement of a neoplasm from one organ to another not directly connected with it; the histological type is the same in both organs. The subheading /second is used on the site to which the tumor has gone (an organ-neoplasms term), and also on the histologic type term (since the histology is the same in both the primary and secondary locations). The subheading /pathology should be used on the organ-neoplasms term indicating the original site, if the original site is relevant to the article and must be indexed. Pulmonary metastases of bone cancer. BONE NEOPLASMS / * pathol LUNG NEOPLASMS / * second Metastasis of thyroid papillary adenocarcinoma to the lung. THYROID NEOPLASMS / * pathol LUNG NEOPLASMS / * second ADENOCARCINOMA, PAPILLARY / * second Surgery of Wilms' tumor metastatic to the orbit. ORBITAL NEOPLASMS / * second / * surg NEPHROBLASTOMA / * second / * surg (KIDNEY NEOPLASMS / pathol only if discussed) The term NEOPLASM METASTASIS exists in MeSH, but it should be reserved for articles in which there is neither a secondary site (organ-neoplasms term) nor a histologic type term with which to use /second. Such articles are very rare! Metastatic breast cancer. (The cancer arose elsewhere and went to the breast.) BREAST NEOPLASMS / * second Metastatic breast cancer. (The cancer arose in the breast and went to other organs, but no histologic type is given and no metastatic site is discussed.) BREAST NEOPLASMS / * pathol NEOPLASM METASTASIS Metastatic breast squamous cell carcinoma. (The squamous cell carcinoma arose elsewhere and went to the breast, but the site of the original neoplasm is not given.) BREAST NEOPLASMS / * second CARCINOMA, SQUAMOUS CELL / * second Metastatic breast squamous cell carcinoma. (The squamous cell carcinoma arose in the breast and went elsewhere, but no particular site of the metastasis is discussed.) BREAST NEOPLASMS / * pathol CARCINOMA, SQUAMOUS CELL / * second For a further discussion of the subheading /second and NEOPLASM METASTASIS, see sections 24.3.1 and 24.4.1.3+. Terms which should also be considered before indexing the subheading /second include: LYMPHATIC METASTASIS (section 24.4.1.4) NEOPLASM INVASIVENESS (24.4.1.1+) NEOPLASM RECURRENCE, LOCAL (24.4.1.5) NEOPLASM SEEDING (24.4.1.11) NEOPLASMS, MULTIPLE PRIMARY (24.4.1.6) NEOPLASMS, SECOND PRIMARY (24.4.1.7) NEOPLASMS, UNKNOWN PRIMARY (24.4.1.8) 19.8.66 /secretion /SE, /secret Used for the discharge across the cell membrane, into the intracellular space or ducts, of endogenous substances resulting from the activity of intact cells of glands, tissues, or organs. /secret is allowed with organs (Category A) and endogenous substances (Category D). In addition, it is an AQ for most neoplasm terms, since neoplasms may be viewed as tissue; it is not an AQ, however, for leukemias or lymphomas, which are not solid tumors. Insulin secretion by the islands of Langerhans. INSULIN / * secret ISLANDS OF LANGERHANS / * secret Effect of reserpine on adrenal gland secretions. ADRENAL GLANDS / * drug eff / * secret RESERPINE / * pharmacol Sympathetic control of glucagon release from the pancreas. GLUCAGON / * secret ISLANDS OF LANGERHANS / * secret SYMPATHETIC NERVOUS SYSTEM / * physiol An HCG-secreting intracranial teratoma. GONADOTROPINS, CHORIONIC / * secret BRAIN NEOPLASMS / * secret TERATOMA / * secret /secret is restricted to use with endogenous substances. Frequently authors use the word "secretion" when they mean "excretion" with reference to exogenous substances. Liver secretion of warfarin into the bile. LIVER / * metab WARFARIN / * metab BILE / * metab (not LIVER / * secret) (not WARFARIN / * secret) 19.8.67 /standards /ST, /stand Used with facilities, personnel, and program headings for the development, testing, and application of standards of adequacy or acceptable performance and with chemicals and drugs for standards of identification, quality, and potency. It includes health or safety standards in industries and occupations. The subheading /stand is used for articles not only on "standards" but also on quality and quality control. The international standard for penicillins. PENICILLINS / * stand Preparation of a hemoglobin reference standard. HEMOGLOBINS / * stand REFERENCE STANDARDS Nursing school standards in Ghana. SCHOOLS, NURSING / * stand GHANA Procedures for assuring the quality of hospital emergency services in teaching hospitals. HOSPITAL EMERGENCY SERVICE / * stand HOSPITALS, TEACHING / * stand * QUALITY ASSURANCE, HEALTH CARE Impact of PSRO on community mental health centers. * PROFESSIONAL REVIEW ORGANIZATIONS COMMUNITY MENTAL HEALTH CENTERS / * stand Do not use /stand for articles evaluating the effectiveness of procedures or programs. Is MRI of value in patients with low back pain? * MRI LOW BACK PAIN / * pathol (not MRI / * stand) 19.8.68 /statistics & numerical data /SN, /statist Used with non-disease headings for the expression of numerical values which describe particular sets or groups of data. It excludes manpower distribution for which "manpower" is used and excludes supply or demand for which "supply & distribution" is used. This subheading, like all other two-part subheadings (e.g., /prevention & control), may be used for articles presenting either statistics or numerical data; both concepts do not need to be present for /statist to be indexed. Social security beneficiaries 1980-1988. SOCIAL SECURITY / * statist UNITED STATES Estimating bed occupancy in nursing homes. BED OCCUPANCY / * statist NURSING HOMES / * util Although /statist is an AQ for many terms, a more specific subheading should be used if possible. By MeSH definition, statistics on manpower or supply are indexed as /manpower or /supply & distribution, respectively. In addition, the Subheading Trees (Figure 19.5) show that statistical aspects of diseases are indexed with the subheadings /epidemiology, /ethnology, or /mortality. Statistics on the supply of pacemakers in Switzerland. PACEMAKER, ARTIFICIAL / * supply SWITZERLAND Statistics on survival in multiple trauma. MULTIPLE TRAUMA / * mortal SURVIVAL RATE Data on the availability of nurses in Great Britain. NURSES / * supply GREAT BRITAIN Data on nursing personnel in Great Britain. NURSING / * man GREAT BRITAIN Some concepts such as /economics or /utilization are often discussed from a statistical standpoint. In these cases, index the specific subheading needed (/econ, /util, etc.); if the statistics are especially important, /statist should be added (NIM) as a second subheading, since MeSH has not defined these concepts or treed them as specific aspects of /statist. Statistics on the utilization of pacemakers in Switzerland. PACEMAKER, ARTIFICIAL / * util / statist SWITZERLAND When /statist is needed with a main heading for which it is not an AQ, add the term STATISTICS (NIM). Statistics on the presence of pollutants in the environment. * ENVIRONMENTAL POLLUTANTS STATISTICS 19.8.69 /supply & distribution /SD, /supply Used for the quantitative availability and distribution of material, equipment, health services, and facilities. It excludes food supply and water supply in industries and occupations. Availability of antibiotics in developing countries. ANTIBIOTICS / * supply * DEVELOPING COUNTRIES Distribution of community health services in the United States. COMMUNITY HEALTH SERVICES / * supply UNITED STATES The shortage of hospital libraries. LIBRARIES, HOSPITAL / * supply The dwindling number of minority group nurses. NURSES / * supply * MINORITY GROUPS /supply is sometimes confused with /manpower. It is easy to confuse the subheadings because they both can be used for personnel; /man is defined exclusively in terms of personnel, and /supply includes the availability of personnel as well as services, equipment, and facilities. The difference is that /man is used with fields and disciplines for studies on the numbers of any personnel in that field, while /supply is used with "people" terms for the numbers of just those people. Compare these examples: NURSING / man vs NURSES / supply PHARMACY / man vs PHARMACISTS / supply DENTISTRY / man vs DENTISTS / supply In each of these examples, /man can refer to any personnel within the field (for example, the field of dentistry includes dental technicians, etc., not just DENTISTS), but /supply refers only to the named group of people. For further discussion of /man and /supply, see sections 19.8.43 and 35.2.5. 19.8.70 /surgery /SU, /surg Used for operative procedures on organs, regions, or tissues in the treatment of diseases, including tissue section by lasers. It excludes transplantation, for which "transplantation" is used. This subheading may be used on organs, diseases, and animal terms. Surgery of the liver in liver diseases. LIVER / * surg LIVER DISEASES / * surg Hepatectomy in cancer of the liver. LIVER NEOPLASMS / * surg * HEPATECTOMY Cryosurgery of facial dermatitis. FACIAL DERMATOSES / * surg * CRYOSURGERY Adaptation of microsurgical instruments for use with cattle. MICROSURGERY / * vet / instrum CATTLE / * surg EQUIPMENT DESIGN /surg is used for all articles on surgical treatment of a disease, even if the organ operated upon is only indirectly involved in the disease. Thymectomy in the treatment of myasthenia gravis. * THYMECTOMY MYASTHENIA GRAVIS / * surg Ovariectomy in breast cancer. BREAST NEOPLASMS / * surg * OVARIECTOMY FEMALE (check tag) HUMAN (check tag) When surgery is performed in a patient with an unrelated disease, however, /surg cannot be used on the disease not being treated. The surgical risk in hemophilia. * HEMOPHILIA * SURGICAL PROCEDURES, OPERATIVE RISK (not HEMOPHILIA / * surg) Surgery for liver diseases in obese patients. LIVER DISEASES / * surg / compl OBESITY / * compl (not OBESITY / * surg) Although the MeSH definition for /surg states that it excludes transplantation because the subheading /transplantation exists, /transpl is an AQ only for organs, not diseases. Therefore, the subheading on the disease being treated by transplantation is /surg. Adrenal gland transplantation in the treatment of parkinsonism. ADRENAL GLANDS / * transpl PARKINSON DISEASE / * surg For a further discussion of /surg and various surgical procedures, see sections 26.15+ through 26.20+. 19.8.71 /therapeutic use /TU, /ther use Used with drugs, biological preparations, and physical agents for their use in the prophylaxis and treatment of disease. It includes veterinary use. This subheading seldom poses problems, as most articles clearly indicate that the drug or physical agent is being used in treatment. The MeSH definition allows its use with veterinary animals but it is used also for experimental diseases in animals. If the drug or physical agent is studied to learn its effectiveness in treating a disease, whether clinical or experimental, /ther use is the correct subheading. Hydralazine therapy of hypertension. HYPERTENSION / * drug ther HYDRALAZINE / * ther use Effect of indomethacin therapy on experimental nephritis in rats. INDOMETHACIN / * ther use NEPHRITIS / * drug ther RATS (check tag) Erythromycin treatment of a streptococcal infection in a beagle. STREPTOCOCCAL INFECTIONS / * vet / drug ther ERYTHROMYCIN / * ther use DOG DISEASES / * drug ther DOGS (check tag) CASE REPORT (check tag) Vidarabine in the treatment of herpesvirus laryngitis. HERPESVIRUS INFECTIONS / * drug ther LARYNGITIS / * drug ther / virol VIDARABINE / * ther use Local cooling in the treatment of burns. BURNS / * ther COLD / * ther use 19.8.72 /therapy /TH, /ther Used with diseases for therapeutic interventions except drug therapy, diet therapy, radiotherapy, and surgery, for which specific subheadings exist. The concept is also used for articles and books dealing with multiple therapies. The treatment of gout. GOUT / * ther Immunotherapy of autoimmune diseases. AUTOIMMUNE DISEASES / * ther * IMMUNOTHERAPY Psychotherapy of peptic ulcer. PEPTIC ULCER / * ther * PSYCHOTHERAPY Successive heat and cold for experimental contusions in rats. CONTUSIONS / * ther COLD / * ther use HEAT / * ther use COMBINED MODALITY THERAPY RATS (check tag) /ther (not /drug therapy) is the correct subheading with disease terms when a biological product is used in treatment. The correct subheading with the biological product is /therapeutic use. Intensive antitoxin therapy of tetanus. TETANUS / * ther TETANUS ANTITOXIN / * ther use As listed in the definition and shown in the Subheading Trees (Figure 19.5), MeSH has many subheadings for specific types of therapy; a more specific subheading should be used whenever possible. Therapy of herpes simplex with amantadine. HERPES SIMPLEX / * drug ther AMANTADINE / * ther use Radiocobalt therapy of lung cancer. LUNG NEOPLASMS / * radiother COBALT RADIOISOTOPES / * ther use 19.8.73 /toxicity /TO, /tox Used with drugs and chemicals for experimental human and animal studies of their ill effects. It includes studies to determine the margin of safety or the reactions accompanying administration at various dose levels. It is used also for experimental studies of exposure to environmental agents. The subheading /tox is used only for experimental studies to determine whether a compound is toxic, or under what conditions it becomes toxic. Do not confuse with the following: /adverse effects: Used for "side effects" or "complications" of a drug, chemical, or procedure. /contraindications: Used with drugs and procedures for conditions in which the drug should not be given or the procedure performed. /poisoning: Used for the serious condition known as "poisoning", "overdose", or "intoxication". For a full comparison, including examples, of /adv eff, /contra, /pois, and /tox, see section 19.9. 19.8.74 /transmission /TM, /transm Used with diseases for studies of the modes of transmission. This subheading is used for transmission of infectious diseases only. Variability of modes of spread in venereal diseases. SEXUALLY TRANSMITTED DISEASES / * transm The mobility explosion and communicable diseases. COMMUNICABLE DISEASES / * transm * TRAVEL The type of housing in the spread of the common cold. COMMON COLD / * transm * HOUSING Transmission of infectious mononucleosis. INFECTIOUS MONONUCLEOSIS / * transm Zoonotic shigellosis in a zookeeper resulting from exposure to the feces of an infected spider monkey. MONKEY DISEASES / * transm SHIGELLOSIS / * transm / * vet OCCUPATIONAL DISEASES / * microbiol ANIMALS, ZOO / * microbiol SPIDER MONKEY / * microbiol FECES / microbiol ZOONOSES Note: Although /*vet must be the only IM subheading on a veterinary disease (see 19.8.81), in this case /*transm may also be made IM on SHIGELLOSIS for the human disease. Genetic transmission should be indexed with the subheading /genetics, not /transm; see section 19.8.34. A study of the transmission of Huntington disease in 5 generations of a family. HUNTINGTON'S DISEASE / * genet (not: HUNTINGTON'S DISEASE / * transm) 19.8.75 /transplantation /TR, /transpl Used with organs, tissues, or cells for transplantation from one site to another within the same subject, or from one subject to another of the same species or different species. Transplantation is not restricted to whole organs. The subheading /transpl or a TRANSPLANTATION term may be used when a part of an organ is transplanted, but the organ or part, tissue, or cell must be moved from one site to another, with no portion attached in its original position. Therefore, partial detachment and repositioning of organs (in various bypass procedures or urinary diversion, for example) does not fall within the definition of /transpl. MeSH has many pre-coordinated organ-transplantation and blood cell transfusion terms, so the subheading /transpl is not needed often. The terms TRANSPLANTATION, ORGAN TRANSPLANTATION, TISSUE TRANSPLANTATION, CELL TRANSPLANTATION and BLOOD COMPONENT TRANSFUSION are also available but are to be used for general articles only; in most articles a specific organ, tissue, or cell is discussed and should be indexed with the subheading /transpl or as one of the specific pre-coordinated terms available. The following are the transplantation types available in MeSH: TRANSPLANTATION, AUTOLOGOUS--within the same subject. TRANSPLANTATION, HETEROLOGOUS--between different species. TRANSPLANTATION, HETEROTOPIC--to a site different from the normal anatomic location of the organ. TRANSPLANTATION, HOMOLOGOUS--between the same species. TRANSPLANTATION, ISOGENEIC--between genetically identical subjects. Since most visceral transplants are homologous and most skin grafts are autologous, etc., index the AUTOLOGOUS, HOMOLOGOUS and ISOGENEIC transplantation terms only if particularly discussed and only NIM as coordinates for transplantation of a specific organ or tissue. It is not necessary to index them just because the author mentions them in the title with no further discussion of their significance. HETEROLOGOUS and HETEROTOPIC transplantation are rare enough to be indexed as routine coordinates, and indeed are usually made IM. The subheading used on the disease being treated by organ transplantation is /surgery, since /transpl is an AQ only for organs. However, the disease coordinate for BONE MARROW TRANSPLANTATION and BLOOD COMPONENT TRANSFUSION (and its indentions) is /therapy, not /surgery, since these are not surgical techniques. REPLANTATION is the return of organs removed traumatically, and less frequently surgically, to their original location. Do not consider this /transpl; use /surg as the qualifier on the organ. Reimplantation of a partially amputated thumb. AMPUTATION, TRAUMATIC / * surg THUMB / * surg / * inj * REPLANTATION The following are some examples of the use of pre-coordinated TRANSPLANTATION and TRANSFUSION terms, and the subheading /transpl. Transplantation of one lobe of an adult liver in infants with biliary atresia. BILIARY ATRESIA / * surg LIVER TRANSPLANTATION / * methods INFANT (check tag) ADULT (check tag) Platelet transfusion for refractory thrombopenia. THROMBOPENIA / * ther * PLATELET TRANSFUSION Pathology of the islets after homologous transplantation in rats. ISLETS OF LANGERHANS TRANSPLANTATION / * pathol RATS (check tag) (not: TRANSPLANTATION, HOMOLOGOUS) Heterograft tracheal transplants in animals. TRACHEA / * transpl * TRANSPLANTATION, HETEROLOGOUS ANIMAL (check tag) Osteoblast transplantation for ununited fractures. FRACTURES, UNUNITED / * surg OSTEOBLASTS / * transpl (not: CELL TRANSPLANTATION) Experimental transplantation of liver cells in rats. * CELL TRANSPLANTATION LIVER / * cytol RATS (check tag) (not: * LIVER TRANSPLANTATION) 19.8.76 /trends /TD, /trends Used for the manner in which a subject changes, qualitatively or quantitatively, with time, whether past, present, or future. It excludes discussions of the course of disease in particular patients. The word "trends" appears frequently in titles and when seen will probably be correctly indexed with the subheading /trends (provided, of course, that /trends is an AQ for the term used). In addition, /trends will probably be the correct subheading for titles containing words and phrases such as these: anticipating the impact looking ahead changing nature outlook declining perspectives in 19-- emerging planning for expanded role projection to 19-- faces tomorrow prospects for forecast shifts in demand future since 19-- growth then...now... in transition where are we going? Many articles are written on trends on a nationwide or national level. Tend to index such articles with a geographic term. The changing nature of psychotherapy. PSYCHOTHERAPY / * trends The U.S. labor market is still in a vertical climb. EMPLOYMENT / * trends UNITED STATES Pediatric emergency services of the future. EMERGENCY MEDICAL SERVICES / * trends CHILD HEALTH SERVICES / * trends FUTUROLOGY Trends in medical education in Great Britain. EDUCATION, MEDICAL / * trends GREAT BRITAIN The definition of /trends includes reference to "past, present or future." This does not mean that the subheading is a substitute for the main heading FORECASTING. Whether the indexer adds FORECASTING as a coordinate for /trends to designate the future depends in general on the time span. The immediate future usually falls within the scope of "trends"; the remote future falls within the definition of FORECASTING, especially if there is a discussion on extrapolation or interpretation beyond the facts. A rule of thumb on the use of FORECASTING is this: use only the subheading /trends for the immediate future but add FORECASTING for about ten or more years in the future. Specialty hospitals, under pressure, face an uncertain future in the next few years. HOSPITALS, SPECIAL / * trends Rehabilitation in the 1990s. REHABILITATION / * trends But: Nursing care in the 21st century. NURSING CARE / * trends FORECASTING Note! The term FORECASTING is in the SOCIAL SCIENCES tree and should therefore be restricted to uses such as these, not used for "forecasting" or "predicting" the course of a disease in a patient. Can measurements of blood serotonin predict the response to treatment in patients with depressive disorders? SEROTONIN / * blood DEPRESSIVE DISORDERS / * blood / * ther (not FORECASTING) There is no way to index the concept of "trends" if /trends is not an AQ for the main heading in question. The title of the citation will have to show the "trend" slant for the searcher. Changes in the use of germ-free animals over the last ten years. * GERM-FREE LIFE 19.8.77 /ultrasonography /US, /ultrasonogr Used with organs and regions for ultrasonic imaging and with diseases for ultrasonic diagnosis. Does not include ultrasonic therapy. This subheading is to be used with organs and diseases for ultrasonic imaging and ultrasonic diagnosis. When the specific ultrasonographic technique exists as a main heading in MeSH, it should be added as a coordinate. Ultrasonography of the lung. LUNG / * ultrasonogr Ultrasonic diagnosis of ectopic pregnancy. PREGNANCY, ECTOPIC / * ultrasonogr * ULTRASONOGRAPHY, PRENATAL Ultrasonic differentiation of pancreatic neoplasms and cysts. PANCREATIC NEOPLASMS / * ultrasonogr PANCREATIC CYST / * ultrasonogr DIAGNOSIS, DIFFERENTIAL Diagnosis of mitral valve stenosis using color Doppler echocardiography. MITRAL VALVE STENOSIS / * ultrasonogr * ECHOCARDIOGRAPHY, DOPPLER, COLOR 19.8.78 /ultrastructure /UL, /ultrastruct Used with tissues and cells (including neoplasms) and microorganisms for microanatomic structures, generally below the size visible by light microscopy. Unlike the subheadings /anatomy & histology and /cytology, which are reserved for normal structure with /pathology being used for abnormal structure, /ultrastruct is used for both normal and pathological subcellular structure. When /ultrastruct is indexed for pathological ultrastructure, it is not necessary to add /pathol as a second subheading. However, /ultrastruct is not an AQ for any diseases except neoplasms, so the subheading used on any non- neoplastic disease is /pathol. Nucleolar structure in plants. PLANTS / * ultrastruct CELL NUCLEOLUS / * ultrastruct Ultrastructure of staphylococci and HIV-1 in the kidney. KIDNEY / * microbiol / virol STAPHYLOCOCCUS / * ultrastruct HIV-1 / * ultrastruct Liver lysosomes in hepatitis and liver neoplasms. LIVER / * ultrastruct LYSOSOMES / * ultrastruct HEPATITIS / * pathol LIVER NEOPLASMS / * ultrastruct /ultrastruct is not an AQ for vertebrates (Category B2), although it is allowed with other Category B organisms. Ultrastructure of the feline seminiferous tubule. SEMINIFEROUS TUBULES / * ultrastruct CATS / * anat (not CATS / * ultrastruct) /ultrastruct is used with proteins, enzymes, and nucleic acids for studies of their gross structure performed using electron microscopy. Electron microscopy studies of DNA. DNA / * ultrastruct MICROSCOPY, ELECTRON 19.8.79 /urine /UR, /urine Used for the presence or analysis of substances in the urine, and also for the examination of, or changes in, the urine in disease. Urinary urea in lactating cows. CATTLE / * urine UREA / * urine LACTATION / * urine Urinary estrogen excretion in pregnant mares. HORSES / * urine ESTROGENS / * urine PREGNANCY, ANIMAL / * urine Urinary excretion of corticosteroids in breast cancer. BREAST NEOPLASMS / * urine CORTICOSTEROIDS / * urine Chromatography of urinary 17-ketosteroids. 17-KETOSTEROIDS / * urine CHROMATOGRAPHY Urine cytology in kidney tumors. KIDNEY NEOPLASMS / * urine URINE / cytol 19.8.80 /utilization /UT, /util Used with equipment, facilities, programs, services, and health personnel for discussions, usually with data, of how much they are used. It includes discussions of overuse and underuse. This subheading is indexed primarily for articles on health care and health services which discuss the degree of use; i.e., is a piece of equipment or a given service or specific personnel used at all? used much? used seldom? used under certain conditions? The subheading is not to be used with a Category E heading for articles on how the equipment or technique is to be used, but rather on how much it is used. "The use of ECG to diagnose heart disease" is not within the scope of /util. However, /util would correctly apply to this concept: "Is ECG used much in outland areas of Sumatra?" Who uses Medicare? MEDICARE / * util UNITED STATES Use of dental technicians in special hospitals. DENTAL TECHNICIANS / * util HOSPITALS, SPECIAL / * man Non-users of health services. HEALTH SERVICES / * util Effective use of hospitals and hospital medical staffs. HOSPITALS / * util HOSPITAL MEDICAL STAFF / * util How frequently are cesarean sections performed in the United States versus France? CESAREAN SECTION / * util UNITED STATES FRANCE COMPARATIVE STUDY (check tag) HUMAN (check tag) FEMALE (check tag) PREGNANCY (check tag) As can be seen in some of the examples given above, a common coordinate for articles indexed with /util is one of the geographic headings from Category Z. 19.8.81 /veterinary /VE, /vet Used for naturally occurring diseases in animals, or for diagnostic, preventive, or therapeutic procedures used in veterinary medicine. /vet is used with disease terms for articles on veterinary diseases (i.e., not laboratory models of human disease). When /*vet is used on a disease, a pre-coordinated animal-diseases term should be added IM to indicate the species in which the disease is occurring, and the animal name should be added NIM as a main heading or a check tag. Brucellosis in dogs. BRUCELLOSIS / * vet * DOG DISEASES DOGS (check tag) ANIMAL (check tag) If an IM subheading is used on the animal-diseases term, it should be added to the term for the disease type but should be made NIM; the IM subheading for a veterinary article should always be /*vet. Thiabendazole therapy of intestinal parasites in sheep. INTESTINAL DISEASES, PARASITIC / * vet / drug ther SHEEP DISEASES / * drug ther THIABENDAZOLE / * ther use SHEEP ANIMAL (check tag) When the Category C term indexed with /vet is a MeSH heading for an abnormality or injury rather than a disease, the coordination should be the name of the animal with /*abnorm or /*inj rather than a pre-coordinated animal- diseases term. Occurrence of diaphragmatic eventration in pigs. DIAPHRAGMATIC EVENTRATION / * vet / epidemiol SWINE / * abnorm ANIMAL (check tag) (not SWINE DISEASES / * epidemiol) Spinal injuries in horses. SPINAL INJURIES / * vet HORSES / * inj ANIMAL (check tag) (not * HORSE DISEASES) /vet is not an AQ for any term in Category C22, a tree devoted exclusively to animal diseases; when a term is indexed from Category C22, the veterinary aspect is inherent. Nairobi sheep disease. * NAIROBI SHEEP DISEASE SHEEP ANIMAL (check tag) Antibiotic treatment of Salmonella infections in horses. SALMONELLA INFECTIONS, ANIMAL / * drug ther ANTIBIOTICS / * ther use HORSE DISEASES / * drug ther HORSES ANIMAL (check tag) If no pre-coordinated animal-diseases term exists for the particular animal studied, the animal name itself should be indexed IM. Dermatitis in minks. DERMATITIS / * vet * MINK ANIMAL (check tag) The other use of /vet is with diagnostic and therapeutic procedures performed on veterinary animals. Again, when the procedures are being tested in laboratory animals as a model of human use, the subheading /vet should not be used. Amputation of the hindlimb of a German shepherd. DOGS / * surg AMPUTATION / * vet HINDLIMB / * surg ANIMAL (check tag) CASE REPORT (check tag) A new surgical retractor for use in surgery on large zoo animals. ANIMALS, ZOO / * surg SURGICAL INSTRUMENTS / * vet ANIMAL (check tag) For a further discussion of veterinary diseases, see section 23.33+. 19.8.82 /virology /VI, /virol Used with organs, animals, and higher plants and with diseases for virologic studies. For bacteria, rickettsia, and fungi, "microbiology" is used; for parasites, "parasitology" is used. This subheading is used like the subheading /microbiology (section 19.8.46), of which it is a subset. When viruses are studied in organs, animals, plants, or diseases (even if they are not the cause of the disease), the subheading /virol should be used. Use of PCR to demonstrate the presence of human papillomavirus 16 as a cause of cervical intraepithelial neoplasia. PAPILLOMAVIRUS, HUMAN / * isol / genet PAPOVAVIRIDAE INFECTIONS / * diag / compl TUMOR VIRUS INFECTIONS / * diag / compl CERVICAL INTRAEPITHELIAL NEOPLASIA / * virol CERVIX NEOPLASMS / * virol DNA, VIRAL / anal POLYMERASE CHAIN REACTION HUMAN (check tag) FEMALE (check tag) Isolation of cowpea mosaic virus from various legumes. COWPEA MOSAIC VIRUSES / * isol LEGUMES / * virol When an article discusses the genetics of a virus involved in an infection, use /genetics on the virus but /virol on the infection. Save /genet with infections for the genetics of the patients. Complete nucleotide sequence of a hepatitis B virus DNA derived from a patient with hepatitis B. HEPATITIS B VIRUS / * genet DNA, VIRAL / * chem HEPATITIS B / * virol BASE SEQUENCE MOLECULAR SEQUENCE DATA (not HEPATITIS B / * genet) Since /virol is indented under /microbiol in the Subheading Trees (Figure 19.5), /microbiol may be used for grouping purposes if an article discusses viruses along with other microorganisms. Demonstration of Ureaplasma urealyticum, Malassezia furfur and cytomegaloviruses on the skin of preterm neonates. UREAPLASMA UREALYTICUM / * isol MALASSEZIA / * isol CYTOMEGALOVIRUS / * isol SKIN / * microbiol / virol INFANT, PREMATURE / * microbiol / virol HUMAN (check tag) INFANT, NEWBORN (check tag) Although not listed in the scope note, /virol is an AQ for organisms in Categories B1 (the invertebrates), B3 (bacteria), and B5 (algae and fungi) as well as for higher animals and plants. Bacteriophages, which are bacterial viruses, are therefore indexed using the subheading /virol on the bacterium infected. Streptococcus pneumoniae bacteriophages share an extremely conserved DNA fragment. STREPTOCOCCUS PHAGES / * genet STREPTOCOCCUS PNEUMONIAE / virol DNA, VIRAL / * chem * CONSERVED SEQUENCE BASE SEQUENCE (MOLECULAR SEQUENCE DATA if a sequence of 9 or more bases is shown) 19.9 COMPARISON OF /ADV EFF, /CONTRA, /POIS, /TOX The subheadings /adverse effects, /contraindications, /poisoning, and /toxicity can be very difficult for an indexer to differentiate. They must, however, be used according to indexing policies and their MeSH definitions, not necessarily the words of the author. The following discussion compares the four subheadings. 19.9.1 /adv eff (See also section 19.8.3 for its MeSH definition): This subheading is used for articles on "side effects" or "complications" of diagnostic or therapeutic procedures. It may also be used for "side effects" of drugs and chemicals, when they are administered deliberately (for therapeutic, pharmacologic, or diagnostic purposes) but unintended harmful effects occur in the patient or animal. An additional use of /adv eff is with environmental pollutants when exposure to relatively low levels (including occupational exposure) causes disease or other harmful effects. 19.9.2 /contra (See also section 19.8.19 for its MeSH definition): This subheading should not be as difficult as the others to use correctly, because authors tend to use the word "contraindication" or some variant of it when the subheading applies. It describes conditions when a drug should not be given, or a diagnostic or therapeutic procedure should not be performed. 19.9.3 /pois (See also section 19.8.57 for its MeSH definition): This subheading is used for articles on the serious condition known as "poisoning", "overdose", or "intoxication" in animals or humans. It may be used for articles about exposure to environmental or occupational pollutants, but the feature distinguishing it from /adv eff in these situations is the degree (very high levels of exposure rather than low levels). Authors will often use the actual word "poisoning" when environmental poisoning occurs. Be careful when using /pois since there are many pre-coordinated terms available in MeSH (CADMIUM POISONING, MERCURY POISONING, etc.). 19.9.4 /tox (See also section 19.8.73 for its MeSH definition): This subheading is for experimental studies in humans or animals only (not microorganisms), where the point is to see whether a compound is toxic, or under what circumstances it becomes toxic (for example, at what dose level). Experimental studies of therapy, in which unintended harmful effects occur, should be indexed as /adv eff; for /tox to be used the intention of the study from the start must be to determine toxicity. The subheading thus will rarely be used for human studies (although volunteers are sometimes recruited for such studies and Phase I studies of drugs may meet the criteria). Even when an author uses the word "toxicity" or a word with "toxicity" as a suffix (nephrotoxicity, etc.), the subheading /tox must not be used except in these experimental circumstances. 19.9.5 When /adv eff, /pois, or /tox is used with a drug or chemical term, the usual coordinate on any disease produced is /chem ind; when /adv eff is used with a procedure, the usual coordinate on any disease produced is /etiol. Examples of the correct use of the 4 subheadings: 19.9.6 /adv eff Hepatotoxicity of acetaminophen given for fever. ACETAMINOPHEN / * adv eff / ther use LIVER DISEASES / * chem ind FEVER / * drug ther (not ACETAMINOPHEN / * tox) Complications of cryosurgery. CRYOSURGERY / * adv eff Peripheral neuropathy in chemical workers in relation to levels of vinyl chloride in the air. VINYL CHLORIDE / * adv eff AIR POLLUTANTS, OCCUPATIONAL / * adv eff PERIPHERAL NERVE DISEASES / * chem ind OCCUPATIONAL DISEASES / * chem ind * CHEMICAL INDUSTRY 19.9.7 /contra Phenytoin should not be used to treat epilepsy in pregnant women. PHENYTOIN / * contra / ther use EPILEPSY / * drug ther PREGNANCY COMPLICATIONS / * drug ther PREGNANCY (check tag) FEMALE (check tag) Knee prosthesis surgery is contraindicated in the morbidly obese. KNEE PROSTHESIS / * contra * OBESITY, MORBID 19.9.8 /pois Drug treatment of digoxin overdose. DIGOXIN / * pois OVERDOSE / drug ther Fatalities in two workers exposed to high levels of methane gas. METHANE / * pois AIR POLLUTANTS, OCCUPATIONAL / * pois FATAL OUTCOME CASE REPORT (check tag) 19.9.9 /tox LD50 of cocaine in rats. COCAINE / * tox LETHAL DOSE 50 RATS (check tag) Studies to determine if acetaminophen causes hepatotoxicity in guinea pigs. ACETAMINOPHEN / * tox LIVER DISEASES / * chem ind GUINEA PIGS (check tag) Tolerability of ascending intravenous doses of granisetron, a novel serotonin antagonist, in healthy human subjects. GRANISETRON / * tox / admin INJECTIONS, INTRAVENOUS HUMAN (check tag) 19.10 COMPARISON OF /ANAL, /CHEM, /ISOL, /METAB, /PHARMACOKIN The subheadings /analysis, /chemistry, /isolation & purification, /metabolism, and /pharmacokinetics can be very difficult for an indexer to differentiate. The following discussion compares the five subheadings. 19.10.1 /anal (See also section 19.8.6 for its MeSH definition): This subheading is used only with Category D terms (chemicals), for determination of their levels or demonstration of their presence. For endogenous compounds, /anal is used for one-time assays, where the concept of changes in levels is not an issue. Changes in levels, often discussed as having been influenced by drugs, diseases, or physiologic processes, should be indexed as /metab. For exogenous chemicals, /anal is usually reserved for articles where the techniques of performing the analysis are the main point; most studies of the "levels" of these compounds in the body are concerned with their movement to various organs and should be indexed as /pharmacokin. Analysis of compounds in the blood, cerebrospinal fluid, or urine should be covered by the appropriate specific subheading (/blood, /csf, or /urine). Studies on the chemical content of organs and tissues (Category A), microorganisms, parasites and plants (Categories B1 and B3-B6) and neoplasms (Category C4) are indexed with /chem on the Category A, B, or C4 term, coordinated with /anal on the chemicals studied. 19.10.2 /chem (See also section 19.8.15 for its MeSH definition): This subheading can be applied to terms from Categories A, B (except B2), C4 and D, but it has a different meaning for Categories A, B and C4 than for Category D. With Categories A (organs and tissues), B (microorganisms, parasites, and plants) and C4 (neoplasms), /chem refers to the natural chemical content or composition of the organ, organism, tissue, or neoplasm; the Category D term being studied is indexed with the subheading /anal. (The content of enzymes or immune compounds, however, should be indexed as /enzymol or /immunol, respectively, on the organ, organism, tissue, or neoplasm. The content of nucleic acids should be indexed as /genet on the organism or neoplasm and on any Category A term for which it is an AQ; use /chem if /genet is not allowed.) A study of the "content" of an exogenous drug is probably about its pharmacokinetics and should be indexed as /metab on the organ, organism, tissue, or neoplasm. Changes in the content of endogenous chemicals as affected by drugs, disease, or natural physiological processes should also be indexed as the /metab of the organ, organism, tissue, or neoplasm. With Category D terms (chemicals), /chem refers to studies of their chemical characterization, composition, structure and properties. Concepts which will correctly be indexed as /chem include: molecular weight and structure, solubility and other physical chemistry properties, chemical reactions, etc. Although the "characterization" of a compound is to be indexed as /chem, "characterization" of an enzyme usually refers to a study of its activity and should be indexed as /metab; "characterization" of an antigen could be a study of its immunology or genetics and would be indexed as /immunol or /genet in those instances. Studies of the structure of proteins and nucleic acids which are performed with electron microscopy should be indexed as their /ultrastruct rather than /chem. Chemical synthesis of a compound should be indexed as /chemical synthesis. 19.10.3 /isol (See also section 19.8.41 for its MeSH definition): This subheading can be applied to Category B terms (microorganisms and parasites) as well as to Category D terms (chemicals), but its use is different for Category B than for Category D. For microorganisms and parasites, /isol is obviously used for studies where the organisms are isolated; however, it can also be used when the presence of the organism is demonstrated by genetic or immune techniques but the organism is not actually isolated. For chemicals, the compound must actually be isolated or purified for /isol to be used; mere demonstration of the presence of the compound should be indexed as /anal. 19.10.4 /metab (See also section 19.8.44 for its MeSH definition): For Category D terms, this is the most frequently used of the 5 related subheadings. It should be used for articles on changes in levels of endogenous compounds (often discussed as affected by diseases, drugs, or physiological processes) and metabolic changes in structure of all Category D terms. For exogenous chemicals, the following concepts should be indexed as /metab: anabolism, assimilation, binding, catabolism, conversion, degradation, incorporation, mobilization, metabolic pathways, splitting, turnover, utilization. Studies of the movement of exogenous chemicals through the body, without any metabolic changes in the molecule of the compound, should instead be indexed as /pharmacokin. Specific aspects of metabolism such as biosynthesis, deficiency, enzymology, and metabolism in the blood, cerebrospinal fluid or urine should be covered by the appropriate specific subheading (/biosyn, /defic, /enzymol, /blood, /csf, or /urine). 19.10.5 /pharmacokin (See also section 19.8.53 for its MeSH definition): This subheading is to be used for exogenous compounds only, for studies of their movement through the body of the patient or higher animal to which they are administered. The following concepts should be indexed as /pharmacokin for exogenous chemicals in humans or higher animals (not microorganisms): absorption, adsorption, clearance, distribution, kinetics, permeation, release, transport, uptake. Since /pharmacokin is restricted to exogenous compounds, the "tissue distribution" of an endogenous compound cannot be indexed with this subheading; the article is probably a study of the tissues in which the compound naturally occurs, and as such is indexed as /anal of the compound. The other concepts listed above, (absorption, transport, etc.), should be indexed as /metab when the article is about endogenous compounds or exogenous compounds in microorganisms, since /pharmacokin cannot be used. When /pharmacokin is used, the subheading on any organ, tissue, animal, or disease in which the compound is studied is /metab. 19.10.6 Examples of the correct use of the 5 subheadings: Levels of endogenous testosterone in the testis. TESTOSTERONE / * anal TESTIS / * chem Levels of beta-lactam antibiotics in the kidney in relation to their ability to treat urinary tract infections. ANTIBIOTICS, LACTAM / * pharmacokin / * ther use KIDNEY / * metab URINARY TRACT INFECTIONS / * drug ther / * metab Determination of lipids in bacteria. BACTERIA / * chem LIPIDS / * anal An enzyme-linked immunosorbent assay for analyzing digoxin. DIGOXIN / * anal ENZYME-LINKED IMMUNOSORBENT ASSAY Radioimmunoassay in the analysis of digoxin blood levels. DIGOXIN / * blood RADIOIMMUNOASSAY Natural sodium content of the kidney. KIDNEY / * chem SODIUM / * anal Determining estrogen receptors in breast neoplasms. RECEPTORS, ESTROGEN / * anal BREAST NEOPLASMS / * chem Levels of ATPase in the liver. LIVER / * enzymol ATPASE / * anal Activity of ATPase in the liver. LIVER / * enzymol ATPASE / * metab Analysis of DNA in HIV-1. HIV-1 / * genet DNA, VIRAL / * anal Mitochondrial DNA in the muscles of patients with the MERRF syndrome. MITOCHONDRIA, MUSCLE / * genet MERRF SYNDROME / * genet DNA, MITOCHONDRIAL / * metab Determination of IgG in the kidney. KIDNEY / * immunol IGG / * anal Molecular weight and structure of verapamil. VERAPAMIL / * chem MOLECULAR WEIGHT MOLECULAR STRUCTURE Mathematical models of oxidation reactions of morphine derivatives. MORPHINE DERIVATIVES / * chem MODELS, CHEMICAL OXIDATION-REDUCTION Phase transitions of glycosaminoglycans. GLYCOSAMINOGLYCANS / * chem THERMODYNAMICS Analysis of adenine in DNA. ADENINE / * anal DNA / * chem Determination of proline in eye proteins. PROLINE / * anal EYE PROTEINS / * chem Amino acid sequence of tubulin. TUBULIN / * chem AMINO ACID SEQUENCE Structure of tubulin polymers in microtubules determined by electron microscopy. TUBULIN / * ultrastruct BIOPOLYMERS MICROTUBULES / * ultrastruct MICROSCOPY, ELECTRON Diagnosis of tuberculosis by isolation of Mycobacterium tuberculosis from bronchoalveolar lavage fluid. BRONCHOALVEOLAR LAVAGE FLUID / * microbiol MYCOBACTERIUM TUBERCULOSIS / * isol TUBERCULOSIS, PULMONARY / * diag Detection of viral DNA for the demonstration of human papillomavirus 16 in condylomata acuminata. CONDYLOMATA ACUMINATA / * virol DNA, VIRAL / * anal PAPILLOMAVIRUS, HUMAN / * isol (/genet may be added as a second subheading on PAPILLOMAVIRUS, HUMAN if the DNA is actually studied in addition to being used to show the presence of the virus.) Purification of various glycosides from Papaver. GLYCOSIDES / * isol PAPAVER / * chem Demonstration of the presence of various glycosides in Papaver. GLYCOSIDES / * anal PAPAVER / * chem Transport of pituitary gonadotropins is delayed in obesity. GONADOTROPINS, PITUITARY / * metab OBESITY / * metab BIOLOGICAL TRANSPORT / physiol Transport of aspirin to the brain in relation to the rate of pain relief. ASPIRIN / * pharmacokin / * ther use PAIN / * drug ther / * metab BRAIN / * metab BIOLOGICAL TRANSPORT / physiol Transport of calcium in platelets. CALCIUM / * blood PLATELETS / * metab BIOLOGICAL TRANSPORT / physiol 19.11 COMMON SUBHEADING COORDINATIONS The groups below show the most common subheading coordinations, although they cannot always be followed. NOTE: It is possible to make one subheading IM without also making its coordinate IM. When more than one subheading is listed as an option, the choice depends on the article; in most cases, only one of the options will be correct for the article being indexed. DISEASE A / compl....(When it is known that DISEASE A DISEASE B / etiol causes DISEASE B) DISEASE A / compl....(Diseases are associated but DISEASE B / compl cause-effect not established) DISEASE / chem ind DRUG / adv eff DISEASE / diag DRUG / diag use DISEASE / pathol ORGAN / pathol RADIOISOTOPE / diag use DISEASE / radionuclide ORGAN / radionuclide ORGAN / drug eff DRUG / pharmacol ORGANISM / drug eff DRUG / pharmacol ORGAN / metab DRUG / metab or / pharmacokin ORGAN / chem CHEMICAL / anal DISEASE / etiol TECHNIQUE / adv eff DISEASE / ultrasonogr ORGAN / ultrasonogr DISEASE / radiogr ORGAN / radiogr DISEASE / physiopathol ORGAN / physiopathol PHYSIOLOGIC PROCESS / drug eff DRUG / pharmacol PSYCHOLOGIC PROCESS / drug eff DRUG / pharmacol ORGANISM / metab DRUG / metab ORGAN / metab DISEASE / metab RADIOISOTOPE / ther use DISEASE / radiother DISEASE / drug ther DRUG / ther use ORGAN / surg DISEASE / surg ORGAN / transpl DISEASE / surg In the columns below and on the next page, common coordinations used when indexing infectious diseases are paired with those used when indexing other diseases. The reason for the differences is that the compounds analyzed represent different concepts. Analysis of an endogenous compound shows what is happening in the patient's body during the disease studied; in contrast, the presence of a compound from a microorganism or parasite is an indication that the organism is also present in the disease and/or organ studied (i.e., it is an indirect indicator for the organism.) INFECTIOUS DISEASE OTHER DISEASE DISEASE / microbiol+ ORGAN / microbiol+ ORGANISM / isol When an immune compound is analyzed ORGANISM'S IMMUNE CPD / anal++ PATIENT'S IMMUNE CPD / anal++ ORGAN / microbiol+ ORGAN / immunol ORGAN-DISEASE / microbiol+ or DISEASE / immunol/ diag INFECTION / microbiol+ or / diag ORGANISM / isol or / immunol +options include /microbiol, /parasitol, or /virol ++options include /anal, /biosyn, /blood, /csf, /isol, /genet, /metab, and /urine INFECTIOUS DISEASE OTHER DISEASE When DNA or RNA is analyzed ORGANISM'S NUCLEIC ACID/anal++ PATIENT'S NUCLEIC ACID /anal++ ORGAN / microbiol+ ORGAN / chem or /genet ORGAN-DISEASE / microbiol+ or DISEASE / genet / diag INFECTION / microbiol+ or /diag ORGANISM / isol or / genet When an enzyme is studied ORGANISM'S ENZYME / metab++ PATIENT'S ENZYME / metab++ ORGAN / microbiol+ ORGAN / enzymol ORGAN-DISEASE / microbiol+ or DISEASE / enzymol / diag INFECTION / microbiol+ or /diag ORGANISM / enzymol +options include /microbiol, /parasitol, or /virol ++options include /anal, /biosyn, /blood, /csf, /isol, /genet, /metab, and /urine