CHAPTER 26		INDEXING PRINCIPLES FOR CATEGORY E 
 
	(ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC 
	TECHNIQUES AND EQUIPMENT) 
 

26.1		Category E is the MeSH category for techniques and equipment:   
diagnostic, therapeutic, surgical, anesthetic, dental, investigative and  
miscellaneous techniques and instruments, appliances or equipment. 
 

26.2		Techniques are discussed in almost every article indexed.  A  
technique will be indexed under the following circumstances: 
 
-If the technique is mentioned in the title or statement of purpose  
for the article. 
 
-If the technique is described in the text as having a bearing on the results of  
the study. 
 
-If the technique is discussed in the text of the article. 
 
 
 
-If the technique discussed in the article would be useful to a researcher  
 
interested in that technique, even though the specific subject of the article  
might not be of interest to that researcher (in other words, if the technique  
has wide application beyond the article.) 
 

26.2.1	The concepts covered in Chapters 21 through 25, (organs, organisms,  
diseases, drugs and chemicals) are normally indexed as IM concepts.  In  
comparison, concepts from Category E (laboratory methods or techniques) are  
often indexed as NIM concepts, if at all. 
 
This will not hold true all the time, for many times (especially in  
clinical articles) the point of the article is a specific procedure, and in  
those cases that procedure should be an IM concept. 
 

26.2.2	When deciding whether to make a Category E term an IM concept, it  
may be helpful to consider the following: 
		 
-Diagnostic and therapeutic techniques are more likely to be IM  
concepts than are techniques used in research. 
 
Any technique discussed as new or especially unusual will probably  
be an IM concept. 
 
In a journal devoted to a technique, the technique is often an IM  
concept (even if it is commonly seen in other journals as an NIM concept). 
 
If the technique is in the title and/or statement of  
purpose for an article, and is especially discussed in the results section as  
being important, it may be an IM concept. 
 

26.2.3	Frequently, techniques are third-tier and as such should not be  
indexed at all.  See section 20.11 for a discussion of first-, second-, and  
third-tier as it relates to indexing. 
 
For example:  x-rays are routinely taken in the diagnosis of  
fractures;  biopsies are routinely obtained in cancer diagnosis;  PCR and  
molecular cloning are routinely performed in genetics and flow cytometry in  
immunology articles;  and the assay techniques are routinely mentioned in  
chemistry articles.  Unless especially discussed, or in the title or statement  
of purpose, such routine concepts should not be indexed at all.    
 

26.2.4	Do not confuse the subject of the study with the methods used in  
performing it.  The research subject should be made IM, but the techniques are  
usually NIM.   
 
		For example, an article on the effect of epilepsy on hemoglobin  
levels is indexed as  
				EPILEPSY / * blood 
				HEMOGLOBINS / * metab 
				Not:  * HEMOGLOBINOMETRY 
 
		If the author discusses the method of measuring the hemoglobin  
levels, the indexer may add HEMOGLOBINOMETRY as an NIM concept, but if the  
method is merely mentioned, it should not even be indexed. 
 
Similarly, an article about the effect of isoniazid on kidney  
function is indexed as 
				ISONIAZID / * pharmacol 
				ANTITUBERCULAR AGENTS / * pharmacol 
				KIDNEY / * drug eff (/ physiol) 
				Not: * KIDNEY FUNCTION TESTS 
 
The article is not about kidney function tests as a concept, but  
rather about the effects of the drug on the kidney.  Again, KIDNEY FUNCTION  
TESTS or an indention may be added NIM if discussed. 
 
In other words, if the research technique is only a method of  
demonstrating the point of the article, the technique should not be made IM.  If  
it is in the title or statement of purpose or is sub- stantively discussed, it  
is second-tier and should be indexed NIM.  If it is merely mentioned, it is  
third-tier and should not be in- dexed at all. (Exceptions to this policy are  
made for tissue culture and epidemiologic methods only; see sections 26.23+ and  
26.27+.) 
 

26.2.4.1	In the previous examples, MeSH headings were available to cover both  
the subject of the study and the technique used in performing it.  Occasionally,  
however, in an article on a physiologic concept, there is no term to cover that  
concept, but there is a similar Category E term available.  Conversely, there  
may be a physiology term available when what is desired is a technique term. In  
such a case, the term from the wrong tree may be used, but it should be NIM. 
 
			Neutralizing antibodies to HIV-1 in AIDS patients. 
				HIV-1 / * immunol 
				HIV ANTIBODIES / * immunol 
				AIDS / * immunol 
				NEUTRALIZATION TESTS 
			(Here the article was about "neutralizing antibodies", but  
that term does not exist in MeSH.  Instead, the term for the process used to  
show the neutralizing activity was indexed.)  
 
			Gene therapy for brain tumors using intra-tumoral transduction  
with the thymidine kinase gene. 
				BRAIN NEOPLASMS / * ther 
				GENE THERAPY / * methods 
				THYMIDINE KINASE / * genet 
				TRANSDUCTION, GENETIC 
			(Here the article was about transduction as a technique, but  
the MeSH heading is only in Category G as a genetic process.)  
 

26.3		The subheadings available for use with terms in Category E are: 
 
		/adv eff					/parasitol (E7 only) 
		/class					/psychol             
		/contra					/rad eff (-ographies only) 
		/drug eff (-ographies only)		/rehabil (E4 only)         
		/econ					/stand              
		/hist					/statist 
		/instrum (not E7)			/supply (E7 only) 
		/man (E6 only)				/trends           
		/methods (not E7)   			/util   
		/microbiol (E7 only)			/vet  
		/mortal (not E7)			/virol (E7 only) 
		/nurs (not E7)		 
 

26.3.1	Many subheadings listed above are not AQs for all terms or  
subcategories  within Category E;  for example, /drug eff is limited to articles  
on techniques classified as "-ographies" by MeSH (ELECTROENCEPHALOGRAPHY,  
ELECTROCARDIOGRAPHY, etc.) 
 

26.3.2	In addition, although some of the subheadings are available for use  
with many of the terms in Category E, they may not actually be used in indexing  
very frequently.  For example, /class may be used on terms in any of the  
subcategories, but it is rare for us to see articles on the classification of  
procedures or equipment. 
 

26.3.3	In addition to the subheadings listed in section 26.3, SPECIALTY  
subheadings, e.g., /educ, /legis, and /organ, are permitted with a few  
techniques which could also be considered medical specialties. 
 
			Undergraduate education in dental implantology. 
				DENTAL IMPLANTATION / * educ 
				* EDUCATION, DENTAL 
 

26.3.4	Quite a few of the general terms in this category have equivalent or  
near equivalent subheadings available (see section 19.7+). Examples include:  
DIAGNOSIS and /diag, RADIOGRAPHY and /radiogr, and SURGICAL PROCEDURES,  
OPERATIVE and /surg. 
 
 
		Reserve the main headings for general articles only;  when indexing  
an article on a specific topic with which the subheading can be used, always use  
the subheading. 
 
			Use of radiotherapy in Botswana. 
				RADIOTHERAPY / * util 
				BOTSWANA 
 
			Radiotherapy of uterine neoplasms. 
				UTERINE NEOPLASMS / * radiother 
				HUMAN (check tag) 
				FEMALE (check tag) 
				Not:  RADIOTHERAPY (either IM or NIM) 
 
 

26.3.4.1	As discussed in section 19.7.4 to 19.7.7, however, if one of these  
subheadings seems itself to require a subheading, the general main heading  
equivalent may be indexed with the subheading required, but the combination must  
be made NIM. 
 
			Adverse effects of uterine cancer radiotherapy. 
				UTERINE NEOPLASMS / * radiother 
				RADIOTHERAPY / adv eff 
				HUMAN (check tag) 
				FEMALE (check tag) 
 
 

26.3.4.2	When indexing a specific technique available in MeSH indented under  
one of the general main heading equivalents of a subheading, use that subheading  
on the disease or organ indexed. 
 
			Pituitary irradiation for pituitary neoplasms. 
				* PITUITARY IRRADIATION 
				PITUITARY NEOPLASMS / * radiother 
			(PITUITARY IRRADIATION is indented under RADIOTHERAPY.) 
 
			Adverse effects of mammography in the diagnosis of breast  
cancer. 
				MAMMOGRAPHY/ * adv eff 
				BREAST NEOPLASMS / * radiogr 
				HUMAN (check tag) 
				FEMALE (check tag) 
			(MAMMOGRAPHY is indented under RADIOGRAPHY.) 
 

26.3.5	The subheading /adv eff is an AQ for most terms in Category E, since  
most diagnostic and therapeutic procedures can produce side effects.   
			Adverse effects of lymphography. 
				LYMPHOGRAPHY / * adv eff 
 

26.3.5.1	Sometimes the material used in a procedure, rather than the  
procedure itself, produces the adverse reaction.   
 
			Adverse effects of contrast media during lymphography. 
				CONTRAST MEDIA / * adv eff		 
				* LYMPHOGRAPHY  
 

26.3.5.2 	If it is not possible to tell from the article whether the adverse  
effect is from the material or the procedure, use /adv eff on both.  
 
			Steel pins in intramedullary nailing causing bone necrosis. 
				STEEL / * adv eff 
				BONE NAILS / * adv eff 
				OSTEONECROSIS / * etiol 
				FRACTURE FIXATION, INTRAMEDULLARY / * adv eff / instrum 
 

26.3.6	The subheading /contra (for "contraindications", or when a procedure  
should not be performed) is also an AQ for most terms in Category E.   
			Magnetic resonance imaging causes pacemaker malfunction and  
should be avoided in patients with pacemakers. 
				MRI / * contra 
				* PACEMAKER, ARTIFICIAL 
				EQUIPMENT FAILURE 
 

26.3.6.1	Discussions of /contra frequently appear in studies of /adv eff,  
because preventing likely adverse effects is usually what makes a procedure  
contraindicated.  Whether to use /adv eff, /contra, or both depends on whether  
both are discussed or just one of them. 
 
			Side effects of thrombolytic therapy for pulmonary embolism in  
elderly patients. 
			(Author also discusses whether or not it should be used.) 
				PULMONARY EMBOLISM / * drug ther 
				THROMBOLYTIC THERAPY / * adv eff / contra 
				HUMAN (check tag) 
				AGED (check tag) 
 
 

26.3.7	Articles on procedures can discuss methods (/methods) or equipment  
(/instrum) or both.  It is possible to use both subheadings on the procedure, or  
one of them, or neither if there is no real discussion of either. 
 
			Techniques used in laser resection of neoplastic solitary  
pulmonary nodules. 
				LASER SURGERY / * methods 
				PULMONARY NODULE, SOLITARY / * surg 
				LUNG NEOPLASMS / * surg 
 
			Various types of lasers used in the operative treatment of  
patients with tuberculosis of the lungs. 
				LASER SURGERY / * instrum 
				TUBERCULOSIS, PULMONARY / * surg 
 
			Various laser modalities and equipment in the treatment of  
cutaneous basal cell carcinomas. 
				LASER SURGERY / * methods / * instrum 
				SKIN NEOPLASMS / * surg  
				CARCINOMA, BASAL CELL / * surg 
 
			Efficacy of laser iridotomy in patients with primary angle- 
closure glaucoma. 
				* LASER SURGERY 
				IRIS / * surg 
				GLAUCOMA, ANGLE-CLOSURE / * surg 
 

26.3.7.1	If a MeSH heading exists for a technique, but the article is about a  
variation of that technique which does not exist in MeSH, index the technique  
with the subheading /methods to cover the variation (even if methods are not  
particularly discussed). 
 
			Fine-needle myelography. Usefulness in assessing lumbar spinal  
cord compression. 
				MYELOGRAPHY / * methods 
				SPINAL CORD COMPRESSION / * radiogr 
				LUMBAR REGION 
 

26.3.8	The subheading /stand is used with Category E terms for articles  
discussing not only "standards" but also "quality".  The subheading 
		is not used for the evaluation of the effectiveness of a procedure. 
 
			Guidelines for the performance of enteral and parenteral  
nutrition in adult and pediatric patients. American Society for Parenteral and  
Enteral Nutrition. 
				ENTERAL NUTRITION / * stand 
				PARENTERAL NUTRITION / * stand 
				ADULT (check tag) 
				CHILD (check tag) 
				HUMAN (check tag) 
				PRACTICE GUIDELINE (PT)						 
 
			Study of the effectiveness of mammography in detecting tiny  
breast tumors. 
				BREAST NEOPLASMS / * radiogr 
				* MAMMOGRAPHY 
				EVALUATION STUDIES 
				HUMAN (check tag) 
				FEMALE (check tag) 
				Not:  MAMMOGRAPHY / * stand 
 

26.3.9	The subheading /util is used with Category E techniques for studies  
on how much they are used, not for how they are used in diagnosis or therapy.   
It is by nature a statistical concept.   
 
			The use of pacemakers in the treatment of ventricular  
tachycardia. 
			(A review of the indications for pacemakers) 
				TACHYCARDIA, VENTRICULAR / * ther 
				* PACEMAKER, ARTIFICIAL  
				Not:  PACEMAKER, ARTIFICIAL / * util  
 
		If an article on utilization presents a number of statistics, the  
subheading /statist may be used as well, but should be NIM with /util as the IM  
subheading. 
 
			Statistics on the use of pacemakers in Switzerland. 
				PACEMAKER, ARTIFICIAL / * util / statist 
				SWITZERLAND  
 

26.4		Radiographic techniques are used commonly in clinical studies.  
Although the term RADIOGRAPHY is available in MeSH, it should be indexed IM only  
for very general articles on x-ray diagnosis, because many specific radiographic  
techniques are available as MeSH headings, and the subheading /radiogr can be  
used with organs and diseases. 
 

26.4.1	Since radiography is used so frequently, many precoordinated MeSH  
headings are available for the radiography of specific organs.  For example,  
BLOOD VESSELS/radiogr should be indexed as ANGIOGRAPHY;  BILE DUCTS/radiogr  
should be indexed as CHOLANGIOGRAPHY, etc. 
 
		If such a precoordinated term is available, the ANNOTATED MeSH gives  
that information at the entry for the organ;  for example, the entry at AORTA  
states "AORTA/radiography see AORTOGRAPHY". 
 
		Online indexers are reminded by the online indexing system when they  
use the subheading /radiogr on an organ for which a specific radiographic  
technique is available.  Using the example given above, if an indexer tried to  
input 
				AORTA / radiogr 
		the indexing system would respond with the message: 
 
			+++ERROR+++ AORTA/radiogr must be replaced by AORTOGRAPHY and  
possible subheading 
 

26.4.2	When a precoordinated term is available to cover the radiography of  
a general organ system, but the indexer needs to cover the radiography of a more  
specific organ, the subheading /radiogr should be used on the specific organ and  
the general radiographic term should not be added. 
 
			Radiography of the renal veins. 
				RENAL VEINS / * radiogr 
				Not:  PHLEBOGRAPHY 
 

26.4.2.1	If, however, the subheading /radiogr seems itself to require a  
subheading, the general radiographic term may be indexed with that desired  
subheading, but the combination must be made NIM (see section 19.7.7). 
 
			Adverse effects of renal vein radiography. 
				RENAL VEINS / * radiogr 
				PHLEBOGRAPHY / adv eff 
 

26.4.3	When indexing the x-ray diagnosis or x-ray appearance of a disease,  
index only the disease with the subheading /radiogr and do not also add the  
involved organ, either with the subheading /radiogr or as a pre-coordinated  
heading, unless the organ or procedure is specifically discussed. 
 
			X-ray diagnosis of gallbladder disease. 
				GALLBLADDER DISEASES / * radiogr 
				Not: * CHOLECYSTOGRAPHY 
 
			X-ray diagnosis of liver diseases. 
				LIVER DISEASES / * radiogr 
				Not:  LIVER / * radiogr 
 
			But:  Cholangiography in the diagnosis of bile duct disease. 
				BILE DUCT DISEASES / * radiogr 
				* CHOLANGIOGRAPHY 
 
			And:  Radiography of the heart in the diagnosis of congestive         
heart failure. 
				HEART / * radiogr 
				HEART FAILURE, CONGESTIVE / * radiogr 
 

26.5		RADIONUCLIDE IMAGING, (also called SCINTIGRAPHY or RADIOISOTOPE  
SCANNING) is another commonly-used method of diagnostic imaging.  Because it is  
so frequently seen, a subheading (/radionuclide) is available for use with  
organs and diseases.   
 
		In general, the same rules used for RADIOGRAPHY and /radiogr apply  
to RADIONUCLIDE IMAGING and /radionuclide, but there are fewer precoordinated  
MeSH headings available for the radionuclide imaging of specific organs, so it  
is more likely that the subheading /radionuclide will be used. 
 

26.5.1	When indexing articles on radionuclide imaging, the radioisotope  
used is frequently relevant and if so should be indexed with the subheading  
/diag use (either IM or NIM depending upon its importance).   
 
			Myocardial ischemia detected by thallium scintigraphy. 
				MYOCARDIAL ISCHEMIA / * radionuclide 
				THALLIUM RADIOISOTOPES / * diag use 
 

26.5.2	Radioisotopes used in imaging are frequently administered in the  
form of "radiopharmaceuticals".  These are composed of a radioisotope attached  
to a drug which, because of its pharmacokinetic properties, tends to accumulate  
preferentially in certain organs of the body.  By using this drug, the  
radioisotope will be delivered to those organs, which can then be imaged.  Index  
the radioisotope as above, and add the drug with the subheading /diag use (IM or  
NIM depending upon its significance). 
  
			Tumor imaging with iodine-125 5-iodo-2'-deoxyuridine in  
patients with colorectal cancer. 
				COLORECTAL NEOPLASMS / * radionuclide 
				IODINE RADIOISOTOPES / * diag use 
				IDOXURIDINE / * diag use 
 
			The role of iodine-123-Tyr-3-octreotide scintigraphy in the  
evaluation of lung neoplasms. 
				IODINE RADIOISOTOPES / * diag use 
				Tyr-3-octreotide / * diag use 
				LUNG NEOPLASMS / * radionuclide 
			(Tyr-3-octreotide is an entry in the MeSH Chemical File) 
 

26.5.3	One of the radioisotopes commonly used in imaging is technetium 99m.   
Technetium compounds are different from other radiopharmaceuticals;  the  
technetium is actually part of the compound, not just attached to it.  The  
indexing of technetium radiopharmaceuticals is therefore different from the  
instructions given above, as the drug is not indexed separately from the  
technetium.   
 
		Many specific technetium compounds are available as MeSH headings.   
In addition, the term ORGANOTECHNETIUM COMPOUNDS is available. Although most  
indexers will never use that term because most articles are about specific  
compounds, the term is important because of the many technetium  
radiopharmaceuticals in the Chemical File.  Compounds in the Chemical File at  
"technetium Tc 99m" or "Tc-99m" are already mapped (the HM) to ORGANOTECHNETIUM  
COMPOUNDS, so the indexer must not add TECHNETIUM.  Any technetium  
radiopharmaceutical which is not available in MeSH or the Chemical File should  
be flagged (again, the indexer must not index TECHNETIUM). 
 
			Technetium 99 HMPAO scanning in appendicitis.  
				APPENDICITIS / * radionuclide 
				Tc-99m-HMPAO / * diag use 
 

26.6		MAGNETIC RESONANCE IMAGING (with a DF abbreviation of MRI) is  
another common imaging technique.  There is no subheading available in MeSH to  
cover this technique, however, so the indexer must index the term itself. 
 
		MRI can be used in two ways to study disease: 
 
		-	If the MRI is used to see whether a disease exists, the  
subheading /diag should be used on the disease term indexed. 
 
		-	If the MRI is used to determine the extent of a previously  
diagnosed disease, the subheading /pathol should be used on the disease. 
 
		In both instances, the subheading /pathol should be used on the  
organ imaged.  If a non-diseased organ is imaged, the subheading used on it  
should be /anat. 
 
			Diagnosis of a tumor in the hippocampus using magnetic  
resonance imaging. 
				HIPPOCAMPUS / * pathol 
				BRAIN NEOPLASMS / * diag 
				MRI 
 
			Brain atrophy in Huntington's disease: an MRI study. 
				HUNTINGTON'S DISEASE / * pathol 
				BRAIN / * pathol 
				ATROPHY / pathol 
				MRI  
		   

26.6.1	A term which should be differentiated from MAGNETIC RESONANCE  
IMAGING is MAGNETIC RESONANCE SPECTROSCOPY see NUCLEAR MAGNETIC RESONANCE (which  
has a DF abbreviation of NMR).  The difference between the concepts is that MRI  
demonstrates the internal anatomy of an organ, and NMR is a spectroscopic  
procedure used to demonstrate the presence of chemicals.  The correct subheading  
on the organ will therefore be /chem or /metab, coordinated with /metab on any  
disease studied. 
 
		If the author uses  the term "magnetic resonance spectroscopy" but  
the article is really about the imaging of an organ, the indexer should index  
MRI as the more specific concept.                       
 

26.7		LABORATORY TECHNIQUES AND PROCEDURES is reserved for general  
articles only, such as "Medicare coverage of laboratory diagnosis" or "The  
comparative value of diagnostic imaging and laboratory diagnosis".  Such  
articles are fairly infrequent. 
 
			Mechanisms of reimbursing for laboratory diagnosis. 
				* REIMBURSEMENT MECHANISMS 
				LABORATORY TECHNIQUES AND PROCEDURES / * econ  
 
		Aside from diagnostic imaging, most diagnosis of disease relies on  
laboratory procedures, so for most articles only the specific procedure should  
be indexed. 
 
			Laboratory diagnosis of hemochromatosis based on blood copper  
levels. 
				HEMOCHROMATOSIS / * diag / blood 
				COPPER / * blood 
				Not:  LABORATORY TECHNIQUES AND PROCEDURES (IM or NIM) 
 
 

26.8		ENZYME TESTS is used for the measurement of enzymes in the diagnosis  
of a disease.  Coordinate ENZYME TESTS with the subheading /diag on the disease,  
not /enzymol (and not /blood, /csf, or /urine if that is where the enzymes are  
measured).  Do not use ENZYME TESTS for all studies on the determination of  
enzyme levels in a disease, only for those articles in which elevated or reduced  
levels are discussed as allowing the diagnosis of the disease.  
 
		The following examples show the use of ENZYME TESTS versus /enzymol. 
 
			Liver enzymes in gout. 
				LIVER / * enzymol 
				GOUT / * enzymol 
 
			Enzyme tests in gout. 
				GOUT / * diag 
				* ENZYME TESTS 
 
			Diagnosis of gout based on liver enzymes. 
				LIVER / * enzymol 
				GOUT / * diag 
				ENZYME TESTS  
 

26.8.1	Do not use ENZYME TESTS for studies in which exogenous enzymes are  
used in diagnosis.  In these studies, the enzymes should be indexed with the  
subheading /diag use (if they are administered) or with no subheading (if they  
are used merely as reagents). 
 
			Diagnosis of gonorrhea using the ligase chain reaction for  
specific detection of Neisseria gonorrhoeae. 
				GONORRHEA / * diag 
				NEISSERIA GONORRHOEAE / * isol  (possibly /genet too) 
				DNA LIGASES (no sub; IM or NIM depending on the article) 
				GENE AMPLIFICATION / methods  (IM or NIM as per article)  
			Early detection and measurement of experimental myocardial  
infarcts in rabbits using intravenous horseradish peroxidase. 
				MYOCARDIAL INFARCT / * diag 
				HORSERADISH PEROXIDASE / * diag use 
				INJECTIONS, INTRAVENOUS 
				RABBITS (check tag) 
				ANIMAL (check tag) 
 

26.9		SEROLOGIC TESTS are diagnostic procedures involving the measurement  
of some immune compound such as an antibody.  It should be indexed as the /diag  
of the disease in question, not its /immunol. 
 
			Diagnosis of hepatitis B by measurement of blood levels of  
antibodies to the hepatitis B surface antigen. 
				HEPATITIS B / * diag   
				HEPATITIS B ANTIBODIES / * blood 
				HEPATITIS B SURFACE ANTIGENS / * immunol  
				SEROLOGIC TESTS 
 

26.9.1	SEROLOGIC TESTS as an IM concept is reserved for general articles  
only.  Index an article on the serodiagnosis of a specific disease as above,  
using the disease with the subheading /*diag, coordinated with SEROLOGIC TESTS  
(NIM).  Quite frequently, however, a specific serodiagnostic technique is given,  
and that technique should be indexed instead of the general term SEROLOGIC  
TESTS;  check the Trees for indentions under SEROLOGIC TESTS. 
 
			Serodiagnosis of typhus using complement fixation tests. 
				TYPHUS / * diag 
				* COMPLEMENT FIXATION TESTS  
 

26.9.2	When an author uses the word "serologic," it may refer not to  
serodiagnosis but rather to other serologic studies of immune compounds in the  
disease;  check carefully to see whether the serologic methods are being used in  
diagnosis or if they are being used to demonstrate the state of the immune  
system in the disease (if so, use /immunol on the disease). 
 

26.9.3	Serology is also used in determining the epidemiology of a disease  
(usually infectious) by seeing how many individuals have developed antibodies to  
the disease or the disease organism.  Index such articles as the /epidemiol of  
the disease in question.  A common coordinate is the term SEROEPIDEMIOLOGIC  
METHODS. 
 
			Prevalence of antibodies to hepatitis B in Hungary. 
				HEPATITIS B ANTIBODIES / * blood 
				HEPATITIS B / * epidemiol   
				HUNGARY / epidemiol 
				PREVALENCE 
				SEROEPIDEMIOLOGIC METHODS 
 

26.9.4	The MeSH term SEROLOGY is reserved for the immunologic specialty of   
serology. 
 

26.10		HEMATOLOGIC TESTS are tests used to study the morphology and  
functioning of the blood cells.  The term should not be used for all studies  
done on the blood, such as determination of blood levels of various compounds.   
Note the indentions in the Trees under the term HEMATOLOGIC TESTS to see the  
type of test covered by the concept. 
 

26.11		"Histochemistry" or "cytochemistry" in a title can mean two things;   
it can mean merely the chemistry of a particular tissue or cell, or it can mean  
the specific technique available as the MeSH heading HISTOCYTOCHEMISTRY. 
 
		HISTOCYTOCHEMISTRY means the localization of compounds in tissue  
(histochemistry) or cells (cytochemistry) using microscopic or electron  
microscopic methods.  In other words, the article will show pictures of a given  
tissue, with the chemicals of interest visible in the pictures (through  
staining, autoradiography, etc.).   
 

26.11.1	HISTOCYTOCHEMISTRY should be indexed IM for articles on the field of  
histochemistry or cytochemistry (such as manpower, education, etc.).  More  
often, however, it is merely the research technique for a specific study;  in  
such cases, it should be indexed NIM following the rules given below, or ignored  
completely if third-tier.   
 

26.11.2	HISTOCYTOCHEMISTRY and its indentions should only be indexed for  
articles using the microscopic methods of localizing compounds described in  
26.11;  it should not be a routine coordinate for all studies on the chemistry  
of various tissues (adequately indexed by using the subheading /chem on the  
tissue studied). 
 
			The chemistry of liver cells. 
				LIVER / * chem / cytol 
				Not:  HISTOCYTOCHEMISTRY 
 
			But:	Demonstration of the presence of ATP in the liver using  
histochemical methods. 
			(Pictures of the liver are shown with the ATP as dark spots.) 
				LIVER / * chem 
				ATP / * anal 
				HISTOCYTOCHEMISTRY 
 
 

26.11.3	As can be seen from the example above, the normal indexing of  
HISTOCYTOCHEMISTRY and its indentions is to use /chem on the organ, tissue, or  
cell in which the chemical is located, and /anal on any compound whose presence  
is demonstrated. 
 
		Since /chem is not an AQ for nonneoplastic diseases, the subheading  
used on any disease (except for those in Category C4) will probably be /metab.   
If the author presents the histochemistry as a method of diagnosing the disease,  
/diag may be used instead. 
 
			Glycosaminoglycan content of joint cartilage in normal adults  
and patients with rheumatoid arthritis. Periodic acid-Schiff studies. 
				GLYCOSAMINOGLYCANS / * anal 
				CARTILAGE, ARTICULAR / * chem 
				ARTHRITIS, RHEUMATOID / * metab 
				PERIODIC ACID-SCHIFF REACTION 
				REFERENCE VALUES 
				HUMAN (check tag) 
				ADULT (check tag) 
				 
			Immunocytochemistry of synaptophysin in the diagnosis of  
nervous system tumors. 
				SYNAPTOPHYSIN / * anal 
				NERVOUS SYSTEM NEOPLASMS / * diag 
				IMMUNOHISTOCHEMISTRY 
 

26.11.3.1	Occasionally the histochemical techniques are used to show how a  
drug or disease changes the levels of a compound in a tissue or organ;  in such  
cases, the subheading used on the compound as well as the tissue or organ will  
be /metab.  See also sections 19.10.1, 19.10.2, and 19.10.4 for a discussion of  
/anal and /chem versus /metab. 
 

26.11.3.2	When histochemical methods are used to show an enzyme or immune  
compound in an organ, tissue, or cell, the correct subheading on the anatomic  
term (as well as any disease studied) will be /enzymol or /immunol,  
respectively, rather than /chem.  The subheading on the compound will still be  
/anal. 
 
			CEA immunofluorescence in amelanotic malignant melanoma of the  
anal canal. 
				CEA / * anal 
				MELANOMA, AMELANOTIC / * immunol 
				ANUS NEOPLASMS / * immunol 
				IMMUNOFLUORESCENCE TECHNIQUE 
 

26.11.3.3	HISTOCYTOCHEMISTRY and its indentions can also be used as a method  
in pathology;  by staining certain compounds, the structure of the tissue can be  
demonstrated more easily.  In such cases, use the subheading /pathol on the  
tissue and only add /chem if the chemistry is also discussed.  The subheading  
/anal should still be used on any chemical indexed. 
 
			Immunohistochemical assessment of PCNA levels as a measure of  
proliferative activity in adrenocortical neoplasms.  
			(PCNA stands for "proliferating cell nuclear antigen", a  
marker of cell division.) 
				ADRENAL CORTEX NEOPLASMS / * pathol 
				PROLIFERATING CELL NUCLEAR ANTIGEN / * anal 
				CELL DIVISION 
				IMMUNOHISTOCHEMISTRY 
				 

26.12		MICROSCOPY should be indexed rarely, only for general articles on  
light microscopy or studies comparing routine light microscopy with another kind  
of microscopy.  Do not index every article on /anat, /cytol, or /pathol with the  
heading MICROSCOPY.  Since this is the routine technique used in such studies,  
it is usually third-tier (see section 26.2.3). 
 

26.12.1	MICROSCOPY, ELECTRON is available for articles on ultrastructural  
studies;  however, as with MICROSCOPY, it is often third-tier unless especially  
discussed, in the title or statement of purpose for the article, or if  
significant numbers of micrographs appear in the article. 
 
			Ultrastructure of Salmonella. 
				SALMONELLA/ * ultrastruct 
				Not: MICROSCOPY, ELECTRON (IM or NIM) unless especially        
discussed, or if many micrographs in the article 
 
			Electron microscopic studies of Salmonella. 
				SALMONELLA / * ultrastruct 
				MICROSCOPY, ELECTRON 
 

26.12.2	Other MeSH headings are available for specific types of microscopy  
(see the Trees for indentions under MICROSCOPY).  These are less likely to be  
third-tier than either MICROSCOPY or MICROSCOPY, ELECTRON, but are still  
unlikely to be IM concepts except for general articles or articles from journals  
specifically devoted to microscopy. 
 
 

26.12.3	PHOTOMICROGRAPHY, defined in Dorland's Illustrated Medical  
Dictionary, 28th Edition as "the photograph(y) of a minute object as seen under  
the light microscope...", should not be indexed for every article showing a  
photograph of a microscopic image, even when labelled by the author as a  
"photomicrograph."  Save the term instead for articles on photomicrography as a  
technique, such as "Hints on surgical photomicrography" or "The use of color  
reference area masking in photomicrography." Photomicrographs in an article  
should be indexed only with the appropriate MICROSCOPY heading if the technique  
needs to be indexed at all. 
 

26.13		DIAGNOSIS, DIFFERENTIAL as a general or IM concept is seldom  
encountered in the literature we index.  Our articles are almost always about  
the differential diagnosis of a specific disease or the differentiation between  
two or more diseases. 
 
		DIAGNOSIS, DIFFERENTIAL will be indexed not only for articles using  
the expression "differential diagnosis" itself, but also for the expressions  
"simulating" or "resembling". 
 
 

26.13.1	Index the differential diagnosis of a disease using the subheading  
/diag or a specific indention (IM), coordinated with DIAGNOSIS, DIFFERENTIAL  
(NIM). 
 
			Differential diagnosis of epilepsy. 
				EPILEPSY / * diag 
				DIAGNOSIS, DIFFERENTIAL 
 
			Epilepsy simulating heart arrest. 
				EPILEPSY / * diag 
				HEART ARREST / * diag 
				DIAGNOSIS, DIFFERENTIAL 
 
			Ultrasonography in the differentiation of ovarian cysts and  
appendicitis. 
				OVARIAN CYSTS / * ultrasonogr 
				APPENDICITIS / * ultrasonogr 
				DIAGNOSIS, DIFFERENTIAL 
				HUMAN (check tag) 
				FEMALE (check tag) 
 

26.13.2	The expression "presenting as" may mean DIAGNOSIS, DIFFERENTIAL (or  
even DIAGNOSTIC ERRORS) if the article is about a patient who appears to have  
("presents as") a disease different from the actual one.  However, "presenting  
as" more frequently means that one disease causes another, more apparent,  
disease with which the patient presents. 
 
			Diffuse well-differentiated lymphocytic lymphoma presenting as  
splenomegaly. 
			(The patient came in with obvious splenomegaly;  the article  
was about determining its cause.) 
				SPLENOMEGALY / * etiol 
				LYMPHOMA, SMALL LYMPHOCYTIC / * diag / compl 
 

26.13.3	In traditional Chinese medicine the term "differentiation of  
symptoms and signs" is indexed as follows: 
			* DIAGNOSIS, DIFFERENTIAL 
			* MEDICINE, CHINESE TRADITIONAL 
 
		Outside of traditional Chinese medicine it is rare to have articles  
on DIAGNOSIS, DIFFERENTIAL as a general concept to be made IM. 
 

26.14		Occasionally an author uses the expression "diagnosis of" in  
reference to a symptom.  Examples include:  "Diagnosis of headache" or  
"Diagnosis of cough".  In these cases, the subheading /diag should not be used  
on the heading for the symptom, because what is being diagnosed is its  
underlying cause.  If any causes of the symptom are discussed, they may be  
indexed with the subheadings /diag and /compl, but the subheading on the symptom  
is /etiol. 
 

26.15		Surgery is a topic commonly seen by indexers of both clinical and  
preclinical journals, but it must not be indexed as SURGERY (even for general  
articles).  Most articles are about SURGICAL PROCEDURES, OPERATIVE (Category E4)  
and its indentions.   
 
		Distinguish between SURGERY and its indentions in Category G2 and  
SURGICAL PROCEDURES, OPERATIVE in this way; SURGERY is the specialty or  
profession, while SURGICAL PROCEDURES, OPERATIVE is the act of performing  
surgery on a human or animal for therapeutic or research purposes.  See Chapter  
28 for discussion of the indexing of SURGERY as a specialty. 
 

26.15.1	Historical articles on surgery in general (not a specific surgical  
technique available in MeSH), should be indexed as SURGERY / * hist, not  
SURGICAL PROCEDURES, OPERATIVE / * hist. 
 

26.15.2	The main heading SURGICAL PROCEDURES, OPERATIVE should be used  
relatively infrequently, since the subheading /surg is available, to be used on  
organs, veterinary animals, and diseases.  See section 19.7+ for a discussion of  
the use of a general main heading versus its subheading equivalent. 
 

26.15.3	SURGICAL PROCEDURES, OPERATIVE as an IM heading is used for articles  
on surgery in general, or those on the effects of or risks of surgery in various  
diseases which are not themselves being treated surgically. 
 
			Control of the quality of surgery in Great Britain. 
				SURGICAL PROCEDURES, OPERATIVE / * stand 
				* QUALITY ASSURANCE, HEALTH CARE 
				GREAT BRITAIN 
			 
			Surgical risks in operating on patients with diabetes. 
				* SURGICAL PROCEDURES, OPERATIVE 
				* DIABETES MELLITUS 
				RISK 
				Not:  DIABETES MELLITUS / * surg 
 

26.15.4	SURGICAL PROCEDURES, OPERATIVE may be used as an NIM coordinate when  
the subheading /*surg has been used but the subheading itself seems to require a  
subheading (see section 19.7.4).  However, a more specific indention under  
SURGICAL PROCEDURES, OPERATIVE should be used instead if possible (see section  
19.7.7). 
 
			A new method for performing surgery on the adrenal glands. 
				ADRENAL GLANDS / * surg 
				ENDOCRINE SURGICAL PROCEDURES / methods 
				Not:  SURGICAL PROCEDURES, OPERATIVE / methods 
 
			Economics of femoral vein surgery. 
				FEMORAL VEIN / * surg 
				VASCULAR SURGICAL PROCEDURES / econ 
				Not:  SURGICAL PROCEDURES, OPERATIVE / econ 
 

26.16		Excision or partial excision (also known as resection) of organs is  
a very common type of surgery.  The MeSH headings ending in -ECTOMY are used for  
these techniques.  
 
			Methods for transurethral resection of the prostate in elderly  
men with benign prostatic hyperplasia. 
				PROSTATECTOMY / * methods 
				PROSTATIC HYPERPLASIA / * surg 
				HUMAN (check tag) 
				MALE (check tag) 
				AGED (check tag) 
 

26.16.1	For any disease treated by the surgical removal of an organ, even if  
it is not the organ actually involved in the disease, use the subheading /surg. 
 
			Thymectomy in the treatment of myasthenia gravis. 
				* THYMECTOMY 
				MYASTHENIA GRAVIS / * surg 
			 
			Is castration alone sufficient in the treatment of stage I  
breast cancer? 
				* CASTRATION, FEMALE 
				BREAST NEOPLASMS / * surg / pathol 
				NEOPLASM STAGING 
				HUMAN (check tag) 
				FEMALE (check tag) 
 

26.16.2	For articles on the -ectomy or excision of any organ for which there  
is no -ECTOMY term available in MeSH, index the organ with the subheading  
/*surg. 
 
			Iridectomy for hyphema. 
				IRIS / * surg 
				HYPHEMA / * surg 
 

26.16.3	The -ECTOMY terms may be indexed not only for articles on  
therapeutic excision of an organ, but also for articles in which the excision  
was performed in laboratory animals for research purposes.  In some research  
articles the animals are being used as models to study the surgical procedure  
itself, and in such cases the -ECTOMY term used should be made IM.  More  
commonly, though, the excision is used merely as a technique to study the  
physiology of the excised organ (by observing the response to its removal);  in  
these cases the IM concept for the article should be the organ with the  
subheading /*physiol (note: not /*surg), and the -ECTOMY term should be added  
NIM if at all.  
 
			Effect of adrenalectomy on blood lipids in rats. 
			(The introduction discusses how patients undergoing  
adrenalectomy often develop elevated blood lipid levels, and presents the rats  
as a surgical model.) 
				ADRENALECTOMY / * adv eff 
				HYPERLIPIDEMIA / * etiol 
				RATS (check tag) 
				ANIMAL (check tag) 
 
			Effect of adrenalectomy on blood lipids in rats. 
			(The introduction discusses adrenal gland physiology, not  
surgical procedures.) 
				ADRENAL GLANDS / * physiol 
				LIPIDS / * blood 
				ADRENALECTOMY 
				RATS (check tag) 
				ANIMAL (check tag) 
 

26.17		There are several -OSTOMY (surgery to create an artificial external  
opening) and -OTOMY (any incision) terms available in MeSH, such as THORACOSTOMY  
and THORACOTOMY.  When indexing an article discussing the -ostomy or -otomy of  
an organ for which there is  no MeSH heading available, index the organ with the  
subheading /*surg plus the heading OSTOMY if appropriate. 
 

26.17.1	Many techniques to create an artificial bladder after the excision  
of the bladder end in -ostomy (ureterosigmoidostomy, etc.).  Unlike the -OSTOMY  
terms in 26.17, these are not external openings. Check the Trees under URINARY  
DIVERSION because some of these -ostomy terms are MeSH headings indented there  
(for example, CYSTOSTOMY and URETEROSTOMY).  If we do not have a term for the  
specific procedure, index URINARY DIVERSION (IM), and add any specific organ  
with the subheading /surg (NIM) (but not URETER).  Do not index a term ending in  
-OSTOMY unless it is indented under URINARY DIVERSION. 
 
			Uretero-ileostomy 
		* URINARY DIVERSION 
			ILEUM / surg  
			 	Not:	ILEOSTOMY (IM or NIM) 
 

26.18		MeSH also contains some terms ending in the suffix -PLASTY  
(ARTHROPLASTY, GINGIVOPLASTY, etc.).  In general, -plasty refers to the surgical  
construction or reconstruction of an organ.  For articles on -plasty procedures  
which are not available as MeSH headings, index the organ with the subheading  
/*surg.  Do not coordinate with the term RECONSTRUCTIVE SURGICAL PROCEDURES or  
with the specialty term SURGERY, PLASTIC. 
 
			Treatment of jejunoileal atresia using duodenoplasty. 
				INTESTINAL ATRESIA / * surg 
				JEJUNUM / * abnorm 
				ILEUM / * abnorm 
				DUODENUM / * surg	 
 

26.18.1	Restrict the term RECONSTRUCTIVE SURGICAL PROCEDURES to external  
cosmetic or reconstructive procedures. It is usually an IM concept, in  
coordiation with /*surg on the specific organ, but many specific types of  
reconstructive procedures are available in MeSH as indentions.  
 

26.19		ORTHOPEDIC PROCEDURES are procedures used to treat and correct  
deformities, diseases and injuries to the skeletal system, its articulations and  
associated structures.  It (or one of its many indentions) should be indexed IM  
in coordination with /*surg on a specific bone, joint, and/or bone or joint  
disease. 
 
			Intramedullary fixation of tibial fractures. 
				TIBIAL FRACTURES / * surg 
				* FRACTURE FIXATION, INTRAMEDULLARY 
 

26.20		The term TRANSPLANTATION is available in MeSH, but is rarely used  
because many specific precoordinated organ-transplantation terms and terms for  
types of transplantation are also available.  In addition, the subheading  
/transpl is available to be used with any organ which does not have a  
precoordinated term.  TRANSPLANTATION should be used IM only for articles on the  
concept of transplantation.   
 
			Psychological aspects of transplantation. 
				TRANSPLANTATION / * psychol 
 
			Liver transplantation. 
				* LIVER TRANSPLANTATION 
 
			Transplantation of the adrenal glands. 
				ADRENAL GLANDS / * transpl 
 

26.20.1	TRANSPLANTATION may be added as an NIM coordinate when subheadings  
are needed after the subheading /*transpl has been used on an organ.  (See  
sections 19.7.7 and 26.15.4.)  However, this will rarely be necessary because of  
the availability of terms for the specific types of transplantation. 
	 
 
			Economic aspects of transplantation of the adrenal glands. 
				ADRENAL GLANDS / * transpl 
				TRANSPLANTATION / econ 
 
			Trends in allogeneic transplantation of the adrenal glands. 
				ADRENAL GLANDS / * transpl 
				TRANSPLANTATION, ALLOGENEIC / trends 
 

26.20.2	CELL TRANSPLANTATION is annotated "GEN & unspecified only..."; it  
should not be indexed as a coordinate if a MeSH heading is available for the  
specific cell transplanted, because the subheading /transpl is an AQ for cells.   
(CELL TRANSPLANTATION may, however, be added NIM if another subheading is  
needed, as with TRANSPLANTATION.) 
 
			Side effects of the transplantation of keratinocytes for  
burns.  
				BURNS / * surg 
				KERATINOCYTES / * transpl 
				CELL TRANSPLANTATION / adv eff 
 
		CELL TRANSPLANTATION is more likely to be indexed when no MeSH  
heading exists to cover the transplanted cell.  In such cases, CELL  
TRANSPLANTATION should be indexed IM in coordination with /*cytol on the organ  
from which the transplanted cells were taken. 
 
			Is hepatocyte transplantation a viable alternative in the  
treatment of fulminant liver failure? 
				LIVER FAILURE, FULMINANT / * surg 
				* CELL TRANSPLANTATION 
				LIVER / * cytol 
				Not:  * LIVER TRANSPLANTATION				  
 

26.20.3	The subheading /immunol is an AQ for the transplantation terms, and  
should be used as the coordinate when any of the terms indented under  
TRANSPLANTATION IMMUNOLOGY is indexed. 
 
			Rejection of a heart-lung graft. 
				* GRAFT REJECTION 
				HEART-LUNG TRANSPLANTATION / * immunol 
				Not:  HEART-LUNG TRANSPLANTATION / * adv eff 
 

26.20.4	Note that the MeSH term TRANSPLANTS is available for general  
articles in which the point is the cell, organ, or tissue graft itself, rather  
than the procedure. 
 

26.21		Index anesthesia procedures under the most specific type of  
anesthesia available in Category E3, usually IM. 
 
		Often the coordinate is the name of a surgical procedure from  
Category E4, without a subheading, or the name of an organ or disease with the  
subheading /surg.  These may or may not be IM too, depending on whether the  
point of the article is mainly the anesthesia, or the anesthesia in relation to  
that specific type of surgery. 
 
			Anesthesia in eye surgery. 
				* ANESTHESIA 
				EYE / * surg 
 
			Local anesthesia in eye surgery. 
				* ANESTHESIA, LOCAL 
				EYE / * surg 
 
			Inhalation anesthesia in ambulatory surgery. 
				* ANESTHESIA, INHALATION 
				* AMBULATORY SURGICAL PROCEDURES 
 

26.21.1	Index an article about the use of a specific anesthetic in a  
specific type of anesthesia under both the name of the anesthetic (IM, with no  
subheading) and the type of anesthesia (IM). 
 
			Lidocaine in spinal anesthesia. 
				* LIDOCAINE 
				* ANESTHETICS, LOCAL 
				* ANESTHESIA, SPINAL 
 

26.21.1.1	If, however, the article is about some aspect of the anesthetic  
other than its use in producing anesthesia, the subheading needed to cover that  
aspect should be indexed. 
 
			Pharmacokinetics of lidocaine when administered for spinal  
anesthesia. 
				LIDOCAINE / * pharmacokin 
				ANESTHETICS, LOCAL / * pharmacokin 
				* ANESTHESIA, SPINAL 
 
 

26.21.2	Add ANESTHESIA, OBSTETRICAL as a coordinate for any specific type of  
anesthesia used in delivery (even delivery by cesarean section). 
 
			Epidural anesthesia in cesarean section. 
				* ANESTHESIA, OBSTETRICAL 
				* ANESTHESIA, EPIDURAL 
				* CESAREAN SECTION 
				HUMAN (check tag) 
				FEMALE (check tag) 
				PREGN (check tag) 
 

26.21.3	When indexing ANESTHESIA, SPINAL, do not coordinate with the  
specific vertebra heading to show the location of the spinal injection;   
however, a locational term may be used if one exists to cover that location. 
 
			Lumbar anesthesia. 
				ANESTHESIA, SPINAL / * methods 
				LUMBAR REGION (NIM) 
				Not: LUMBAR VERTEBRAE 
 

26.22		IMMUNOTHERAPY and its indentions are seen frequently in the  
literature, in both clinical articles (for therapy or prevention) and in  
research articles (as methods of studying immunology). 
 

26.22.1	IMMUNOTHERAPY is annotated "GEN only";  when a particular type of  
immunotherapy is used, whether or not treed under IMMUNOTHERAPY, this term  
should not be added.  The subheading used on any disease being treated with any  
type of immunotherapy is /ther. 
 
			Immunotherapy in the treatment of bladder cancer. 
				BLADDER NEOPLASMS / * ther 
				* IMMUNOTHERAPY 
 
			Monoclonal antibodies in the immunotherapy of pulmonary  
tumors. 
				LUNG NEOPLASMS / * ther 
				ANTIBODIES, MONOCLONAL / * ther use 
				Not:  IMMUNOTHERAPY (IM or NIM) 
 
 

26.22.2	IMMUNIZATION (also known as IMMUNOSTIMULATION) is a specific type of  
immunotherapy, in which the body's immunity is enhanced either passively or  
actively.  MeSH headings are available to cover either of these methods, so the  
term IMMUNIZATION itself is rarely needed. 
 

26.22.2.1	In IMMUNIZATION, PASSIVE, the individual receives antibodies;  in  
ADOPTIVE TRANSFER (an indention under IMMUNIZATION, PASSIVE), the individual  
receives previously sensitized immunologic agents (cells or serum).  
IMMUNOTHERAPY, ADOPTIVE is a specific form of ADOPTIVE TRANSFER in which cells  
with antitumor activity are transferred to a tumor-bearing host.  These are all  
considered passive forms of immunization because the body itself does not mount  
the immune response.  
 
		Note the cross-references to these terms;  some of the cross- 
references are seen more frequently in the literature than are the MeSH terms  
themselves: 
 
			IMMUNIZATION, PASSIVE 
				X  IMMUNOGLOBULIN THERAPY 
				X  IMMUNOTHERAPY, PASSIVE 
				X  NORMAL SERUM GLOBULIN THERAPY 
				X  PASSIVE ANTIBODY TRANSFER 
				X  PASSIVE TRANSFER OF IMMUNITY 
				X  SEROTHERAPY 
 
				ADOPTIVE TRANSFER 
				X  ADOPTIVE CELL TRANSFER 
 
			IMMUNOTHERAPY, ADOPTIVE 
				X  ADOPTIVE CELLULAR IMMUNOTHERAPY 
 

26.22.2.2	In IMMUNOTHERAPY, ACTIVE (also known as VACCINE THERAPY), the  
individual is given an antigen such as a vaccine, which enhances immunity by  
causing the body itself to form antibodies.  
 

26.22.2.2.1	Indented under IMMUNOTHERAPY, ACTIVE is the term VACCINATION  
(IMMUNIZATION, ACTIVE) which is the term to be used when vaccines are given in  
the prevention of a disease.  
 
		VACCINATION in Category E, and VACCINES and its indentions in  
Category D, should be discussed together. 
 
		VACCINATION includes the concept of vaccination:  where it is done,  
when it is done, its indications or value, etc., with the emphasis being on the  
procedure.  VACCINES and its many indentions cover articles on the vaccine  
itself, its composition, preparation, storage, etc.  If in doubt about which to  
use for a particular article, favor a specific VACCINE term rather than the  
general term VACCINATION.   
 
 

26.22.2.2.2	Before indexing an article on vaccination, the indexer must  
determine whether the point of the article is the immunity produced by the  
vaccine or the prevention of a disease.  If the article is on immunity, the  
subheading to be used on any disease concept indexed is /immunol;  if it is on  
prevention, the subheading to be used on the disease is /prev.  
 
			The effect of vaccination on immunity in children with  
measles. 
				MEASLES / * immunol 
				* VACCINATION 
				HUMAN (check tag) 
				CHILD (check tag) 
 
			The effect of vaccination on the prevalence of measles in  
India. 
				* VACCINATION 
				MEASLES / * prev / epidemiol 
				PREVALENCE 
				INDIA / epidemiol 
 

26.22.2.2.3	Complications of vaccination in general or an unspecified type of  
vaccination are indexed as VACCINATION / *adv eff.  However, most articles are  
about the complications of a specific vaccine, which should be indexed instead  
(also with the subheading /*adv eff). 
 

26.22.2.2.4	When a vaccine is used for prevention, use /prev on the disease, but  
do not use /ther use on the vaccine term;  save that subheading for vaccines  
used in the treatment of disease.  This policy differs from the policy on drugs,  
in which the subheading /ther use is used on the drug whether it is given for  
/prev or for /drug ther. 
 
		It is possible that no subheading will be needed on a vaccine used  
in prevention, but if the method of administering the vaccine is discussed, use  
/admin on the vaccine term. 
 

26.22.2.3	IMMUNIZATION SCHEDULE may be indexed for any article discussing the  
timing of IMMUNIZATION or any of its indentions (or the administration schedule  
for a specific vaccine, in which case /admin should be used as the subheading on  
the vaccine).  
 

26.22.3	IMMUNOSUPPRESSION, like the other terms indented under  
IMMUNOTHERAPY, may be used for articles on immunosuppression as a technique even  
when it is not therapeutic (for example, in research).   
 
		Indexers must be careful to distinguish IMMUNOSUPPRESSION in  
Category E (the technique) from IMMUNOSUPPRESSION (PHYSIOLOGY) see IMMUNE  
TOLERANCE in Category G (the physiologic process), since authors will say only  
"immunosuppression". 
 
			Methods of immunosuppression after transplantation of the  
small bowel.  
				IMMUNOSUPPRESSION / * methods 
				INTESTINE, SMALL / * transpl 
				 
			Role of tumor necrosis factor in the immunosuppression caused  
by African trypanosomiasis. 
				TUMOR NECROSIS FACTOR / * immunol 
				TRYPANOSOMIASIS, AFRICAN / * immunol 
				* IMMUNE TOLERANCE 
 

26.23		TISSUE CULTURE, ORGAN CULTURE, and CELL CULTURE are rarely indexed  
as IM concepts.  They may be made IM for general articles, or occasionally in  
coordination with a specific tissue, organ or cell culture method (also IM), if  
it is stressed that the culture is relatively unusual or there is a great amount  
of discussion on how to culture the tissue, organ or cell type. 
 
		Other headings available when indexing cultures are VIRUS  
CULTIVATION (also a technique in Category E) and CELLS, CULTURED and its  
indentions (treed under CELLS in Category A). 
 

26.23.1	TISSUE CULTURE or ORGAN CULTURE is indexed routinely as an NIM  
concept when the researcher cultures a whole tissue or organ as opposed to cells  
(in which case CELLS, CULTURED or an indention should be indexed).  When  
applicable, TISSUE (or ORGAN or CELL) CULTURE must be indexed even if merely  
mentioned by the author.  In addition, HUMAN or ANIMAL must be checked and, if  
animal, the animal species source of the tissue must be indexed (NIM or as a  
check tag) if these can be determined from the article.  The type of tissue or  
organ cultured (KIDNEY, etc.) need not be indexed unless the author discusses it  
as relevant.   
 

26.23.2	Distinguish CELL CULTURE (the technique) from CELLS, CULTURED and  
its indentions (the propagated cells themselves).  Articles discussing the  
physiologic properties of particular cells in culture are indexed as CELLS,  
CULTURED (NIM). 
 
			Multilayer culture of periodontal ligament 
			epithelial cells. 
				PERIODONAL  LIGAMENT / * cytol 
				EPITHELIAL CELLS / * cytol 
				* CELL CULTURE 
 
			Production of prostaglandin E2 by cultured 
			periodontal ligament cells. 
				DINOPROSTONE / * biosyn 
				PERIODONTAL LIGAMENT / * metab / cytol 
				CELLS, CULTURED 
 

26.23.3	Index viral culture or growth as VIRUS CULTIVATION.  It should be  
made IM only rarely, as with TISSUE CULTURE above.  However, it will be indexed  
NIM routinely for cultivation of a specific virus (in coordination with /*growth  
on the specific virus cultivated).  The human or animal species source of the  
tissue or cells in which the virus is cultured must be picked up routinely if  
these can be determined from the article, and TISSUE (or ORGAN) CULTURE, or  
CELLS, CULTURED or an indention, must be added.  Again, the type of tissue or  
organ need not be added unless the author discusses it as important (for  
example, if kidneys were chosen because the author is studying why the virus  
causes nephritis).  
 

26.23.4	When indexing one of the CULTURE terms, do not check the tag IN  
VITRO, as such studies are in vitro by definition. 
 

26.23.5	The related subject of CELL LINE is discussed in Chapter 21 and  
section 22.26.1. 
 

26.24		EQUIPMENT AND SUPPLIES is available in MeSH but is indexed  
infrequently since MeSH has also provided many specific types of equipment as  
main headings.  In addition, the subheading /instrum is available, to be used  
with techniques and specialties.  
 

26.24.1	Index an apparatus, instrument, piece of equipment, etc. used in any  
technique or specialty under the heading for the technique or specialty with the  
subheading /instrum.   
			Equipment for chromatography. 
				CHROMATOGRAPHY / * instrum 
 

26.24.1.1	If the specific piece of equipment exists as a MeSH heading, (BEDS,  
SYRINGES, etc.), use that heading instead of using the subheading /instrum on a  
technique or specialty. 
 
			Standards for the scanners used in CAT scans. 
				TOMOGRAPHY SCANNERS, X-RAY COMPUTED / * stand 
				Not:  TOMOGRAPHY, X-RAY COMPUTED / * instrum 
 

26.24.1.2	If a MeSH heading exists for the equipment but it does not imply the  
specific technique or specialty using the equipment, index that technique or  
specialty too with the subheading /instrum. 
 
			A new syringe for use in dermatology. 
				* SYRINGES 
				DERMATOLOGY / * instrum 
				 

26.24.2	As can be seen from these examples, equipment is most commonly  
indexed by using a term for a specialty or technique, with the subheading  
/instrum.  Sometimes, however, the equipment is used specifically for a specific  
organ, disease, or physiologic process, and then that concept must be indexed IM  
also. 
 
			Equipment used in ear exams. 
				DIAGNOSTIC TECHNIQUES, OTOLOGICAL / * instrum 
				Not:  * EAR 
 
			But:  Design of a new machine which enhances the performance  
of biofeedback for headache patients. 
				BIOFEEDBACK / * instrum 
				HEADACHE / * ther 
				EQUIPMENT DESIGN 
 

26.24.3	SURGICAL INSTRUMENTS (holdable in the hand) and SURGICAL EQUIPMENT  
(all other apparatus used in surgery) exist as MeSH headings but they are  
general terms which are rarely indexed.  Instead, the term for the specific  
surgical procedure used in the article should be indexed with the subheading  
/instrum.   
 
			A new instrument which enhances the performance of penetrating  
keratoplasties. 
				KERATOPLASTY, PENETRATING / * instrum 
				Not:  SURGICAL INSTRUMENTS 
 

26.24.3.1	If the term for the specific surgical procedure does not exist in  
MeSH, index the name of a broader surgical procedure with the subheading  
/instrum (IM), and do not add SURGICAL INSTRUMENTS or SURGICAL EQUIPMENT. 
			Instruments used in performing surgery on the fallopian tubes. 
				FALLOPIAN TUBES / * surg 
				GYNECOLOGICAL SURGICAL PROCEDURES / * instrum 
				Not:  SURGICAL INSTRUMENTS 
 

26.24.3.2	If there is no appropriate term in MeSH for either the surgical  
procedure or a surgical specialty, use a nonsurgical specialty from Category G2  
with /instrum (IM) and add SURGICAL INSTRUMENTS or SURGICAL EQUIPMENT (NIM). 
 
			A new instrument for excision of skin without scarring. 
				SKIN / * surg 
				DERMATOLOGY / * instrum 
				CICATRIX / * prev 
				SURGICAL INSTRUMENTS 
 

26.24.4	The E7 Category, which deals with equipment and supplies includes  
the term PROSTHESES AND IMPLANTS with many specific prosthetic devices indented  
under it. Many of these have corresponding terms in E4 for the implantation  
procedure, e.g., BLOOD VESSEL PROSTHESIS in E7 and BLOOD VESSEL PROSTHESIS  
IMPLANTATION in E4. The indexer must decide from the slant of the article which  
concept (or both) to index. 
 
			Granulomas from silicone breast implants. 
				BREAST IMPLANTS / * adv eff 
				GRANULOMA / * etiol 
				BREAST DISEASES / * etiol 
				SILICONES / * adv eff 
				HUMAN (check tag) 
				FEMALE (check tag) 
				Not:  BREAST IMPLANTATION 
 
			Use of tissue expanders in breast implantation. 
				BREAST IMPLANTATION / * methods 
				* TISSUE EXPANDERS 
				HUMAN (check tag) 
				FEMALE (check tag) 
				Not:  BREAST IMPLANTS unless specifically discussed 
 
		Many articles, of course, will discuss both the procedure and the  
implant, in which case both must be indexed, although they need not both be IM. 
 

26.24.5	Also in E7 is the term SURGICALLY-CREATED STRUCTURES. SURGICAL FLAPS  
is indented here, although the other techniques fomerly indented under SURGERY,  
PLASTIC remain in E4 under RECONSTRUCTIVE SURGICAL PROCEDURES. The heading  
SURGERY, PLASTIC itself is in G2 and is reserved for the specialty. 
 

26.24.5.1	SURGICALLY-CREATED STRUCTURES are structures formed from organs, 	 
	parts of organs, or nearby tissue. They appear in Category A10 as well as  
in E7 and can be used with selected A category qualifiers as well as subheadings  
appropriate to E7. 
 
			Functional and urodynamic characteristics of Camey II ileal 
			neobladder. 
			URINARY RESERVOIRS, CONTINENT / * methods / * physiol 
				URINATION 
				URODYNAMICS 
				ILEUM / surg 
 

26.25		DRUG ADMINISTRATION ROUTES and all its indentions (especially  
INJECTIONS) should be indexed IM for general articles, but more frequently they  
are indexed NIM as coordinates for the subheading /admin on a specific drug. 
 
		Do not attempt to index the route of administration for every drug  
indexed.  Index the route only when it is in the title or statement of purpose  
for the article, or is especially discussed.  Administration routes are usually  
third-tier in research performed on animals;  most drugs are given  
intraperitoneally, subcutaneously, by gavage, or intravenously into a tail vein,  
so do not index those routes unless the author especially discusses them. 
 

26.25.1	One route of drug administration that is often indexed incorrectly  
is ADMINISTRATION, TOPICAL.  This is a general term which means application  
directly to an affected surface (even an internal surface such as a cavity).   
Specific types of topical administration include:  ADMINISTRATION, BUCCAL;   
ADMINISTRATION, INTRAVESICAL;  and ADMINISTRATION, RECTAL.  Indexers use the  
term ADMINISTRATION, TOPICAL incorrectly because authors themselves commonly say  
"topical" with reference to administration to the skin.  Such administration  
should be indexed instead with the specific term ADMINISTRATION, CUTANEOUS  
(treed under ADMINISTRATION, TOPICAL). 
 
			Topical terbinafine in the treatment of tinea pedis. 
				terbinafine / * ther use / admin 
				ANTIFUNGAL AGENTS / * ther use / admin 
				TINEA PEDIS / * drug ther 
				ADMINISTRATION, CUTANEOUS 
 

26.26		CLINICAL TRIALS and its indentions should be indexed IM for articles  
on the topic of clinical trials:  their value, methodology, requirements,  
ethics, etc.   
 
			Drug firms' cooperation in clinical trials. 
				* CLINICAL TRIALS	 
				* DRUG INDUSTRY 
 
			Effect of stratified randomization on size and power of  
statistical tests in clinical trials. 
				RANDOMIZED CONTROLLED TRIALS / * methods 
				* STATISTICS 
 

26.26.1	The main heading CLINICAL TRIALS will be used primarily for articles  
discussing the concept of clinical trials in general, for articles about  
clinical trials as a method of research.   
 
		Although the main heading will not be indexed often, the  
corresponding publication type CLINICAL TRIAL will be indexed frequently, for  
any article reporting the results of a specific clinical trial.  Each clinical  
research article must be thoroughly searched to determine if the CLINICAL TRIAL  
publication type is applicable.  See Chapter 17 for a discussion of publication  
types. 
 

26.26.2	Indented under the general main heading CLINICAL TRIALS are headings  
for specific types of clinical trial (CLINICAL TRIALS, PHASE I, etc.).  As with  
the general heading, these main headings should be reserved for articles about  
any of these types of trial.  
 
			Using orthogonal polynomial scores in evaluating data  
collected in phase I and II clinical pharmacology studies. 
				CLINICAL TRIALS, PHASE I / * statist 
				CLINICAL TRIALS, PHASE II / * statist 
				* DATA INTERPRETATION, STATISTICAL 
 
			Methodology of phase III clinical trials of hypocholesteremia  
agents. Do any reliable substitution criteria exist? 
				CLINICAL TRIALS, PHASE III / * methods 
				ANTICHOLESTEREMIC AGENTS / * ther use 
				RESEARCH DESIGN 
 

26.26.2.1	As with CLINICAL TRIALS (main heading) versus CLINICAL TRIAL  
(publication type), the publication types CLINICAL TRIAL, PHASE I;  CLINICAL  
TRIAL, PHASE II;  CLINICAL TRIAL, PHASE III and CLINICAL TRIAL, PHASE IV are  
much more likely to be used than the corresponding main headings, which are  
plural.  When any of these publication types is indexed, the general publication  
type CLINICAL TRIAL is automatically added to the indexing to assist searchers  
who want articles on any type of clinical trial, irrespective of phase. 
 

26.26.2.2	Although all four phases of clinical trials have cross references to  
FDA phases, the main headings and the corresponding publication types are not  
limited to clinical trials within the United States.  If the phase has been  
numbered for a clinical trial from another country, use the corresponding  
heading or publication type.  Thus, a phase III trial from The Netherlands will  
be indexed CLINICAL TRIAL, PHASE III (PT).  An article on standards for phase I  
trials in Great Britain will be indexed CLINICAL TRIALS, PHASE I / * stand and  
GREAT BRITAIN (the geographic term is required because the standards are  
specifically for trials within Great Britain). 
 

26.26.3	The main headings MULTICENTER STUDIES, CONTROLLED CLINICAL TRIALS,  
and RANDOMIZED CONTROLLED TRIALS are also indented under CLINICAL TRIALS.  The  
indexer is again much more likely to use the corresponding publication types  
than these main headings, which should be reserved for articles about the  
concept of that type of study in general. 
 
			In defense of the corporate author for multicenter trials. 
				* AUTHORSHIP 
				* MULTICENTER STUDIES 
				* PUBLISHING 
 
			Required sample size for randomized clinical trials. 
				RANDOMIZED CONTROLLED TRIALS / * methods 
				SAMPLE SIZE     
 

26.26.3.1	Even though the main heading MULTICENTER STUDIES is indented under  
CLINICAL TRIALS, its scope note does not require that the term be limited to  
multicenter clinical trials.  Similarly, the publication type MULTICENTER STUDY  
may also be used for a study which does not meet the requirements for the  
publication type CLINICAL TRIAL.  Many multicenter studies are merely  
observational, and do not meet the clinical trial criteria of being "pre- 
planned, controlled studies of the safety, efficacy, or optimum dosage  
schedule...", but it is still correct to index such studies with the publication  
type MULTICENTER STUDY.  
 
			Presenting features of monoclonal gammopathies: an analysis of  
684 cases. Cooperative Group for the Study and Treatment of Multiple Myeloma. 
				MONOCLONAL GAMMOPATHIES, BENIGN / * diag 
				MULTICENTER STUDY (PT) 
 

26.26.4	Do not restrict the use of CLINICAL TRIALS and its indentions or the  
publication type CLINICAL TRIAL (and the specific types of clinical trial) to  
evaluations of drugs and chemicals.  Techniques and devices can also be the  
subject of clinical trials.  
 
 

26.26.5	The use of one of the CLINICAL TRIAL publication types is not  
sufficient if the article indicates that the study was single- or double-blind.   
The indexer must also add SINGLE-BLIND METHOD (NIM) or DOUBLE-BLIND METHOD (NIM)  
if the author states that either of those research methods was used.  See  
section 26.27+ below. 
 

26.26.6	Review articles which cite or summarize clinical trials, previously  
published elsewhere, should not be indexed with the publication type CLINICAL  
TRIAL.  Use instead the main heading CLINICAL TRIALS or an indention (NIM) if it  
seems important to convey to a searcher that clinical trials were performed, or  
if the concept of clinical trials is discussed.  Keep in mind, however, that  
reviews are indexed non-depth;  CLINICAL TRIALS should not be indexed routinely,  
but only if the clinical trial aspect is of major importance. 
 
			Sumatriptan for the treatment of migraine attacks--a review of  
randomized controlled clinical trials. 
				SUMATRIPTAN / * ther use 
				VASOCONSTRICTOR AGENTS / * ther use 
				MIGRAINE / * drug ther 
				RANDOMIZED CONTROLLED TRIALS 
				REVIEW, TUTORIAL (PT) 
 

26.26.6.1	Also available in MeSH is the main heading META-ANALYSIS with a  
corresponding publication type META-ANALYSIS (PT).  A meta-analysis is "a  
quantitative method of combining the results of independent studies" to provide  
a larger population upon which to base a conclusion, usually of effectiveness.   
It is considered a method of research, not a review of the literature.  
 
		As with CLINICAL TRIALS (main heading) versus CLINICAL TRIAL  
(publication type), the main heading META-ANALYSIS will be indexed relatively  
infrequently, for articles about meta-analyses.  The publication type will be  
indexed much more frequently.  (NOTE!  Both the main heading and the publication  
type are singular, so the indexer must add (PT) at the end of the publication  
type.) 
 
		Since a meta-analysis is by definition a combination of studies, and  
CLINICAL TRIAL OVERVIEWS is an X-reference to the main heading, do not add  
CLINICAL TRIALS (NIM) for a meta-analysis of clinical trials.  If a specific  
type of clinical trial was used for the meta-analysis, that information should  
be indexed using the main heading, NIM.  Do not use any of the REVIEW  
publication types. 
 
			Meta-analysis of phase III trials on anti-androgen treatment  
in patients with advanced prostate cancer. 
				PROSTATIC NEOPLASMS / * drug ther 
				ANDROGEN ANTAGONISTS / * ther use 
				META-ANALYSIS (PT) 
				CLINICAL TRIALS, PHASE III   (NIM) 
				HUMAN (check tag) 
				MALE (check tag) 
 

26.26.6.2	Articles which are not reviews, but provide further analysis of or  
further data from a previously published clinical trial, should be indexed with  
the publication type CLINICAL TRIAL.  
 

26.26.6.3	Occasionally, however, we index studies in which people who had  
participated in an earlier clinical trial are studied for some other reason.  
(For example, a study of their blood pressure changes in the 10 years following  
the trial.)  Researchers find these patients a convenient population to study,  
because extensive baseline data exist for them.  
 
		When indexing such a study, even if the name of the earlier trial is  
in the title of the article, the publication type CLINICAL TRIAL should not be  
indexed because this is not about the trial itself.  
 

26.27		EPIDEMIOLOGIC METHODS and its indentions occupy a large portion of  
Category E5.  Our rules for indexing these terms differ from those for most main  
headings;  we index all epidemiologic methods used in performing a clinical  
study even if such methods are only mentioned.  If an author mentions that the  
study was retrospective, RETROSPECTIVE STUDIES must be indexed, etc.  However,  
it is acceptable to tree the terms and use a more general heading if more than  
three related epidemiologic terms are mentioned. 
 
			Trends in the incidence of non-insulin-dependent diabetes in  
the United States over the last thirty years. 
			(Methods used in determining the incidence include:  surveys,  
interviews, death certificates and registries.  A MeSH heading is available for  
each of these methods, but the only term under which all the headings are treed  
is DATA COLLECTION.) 
				NIDDM / * epidemiol 
				INCIDENCE 
				DATA COLLECTION  
				UNITED STATES / epidemiol 
 

26.27.1	Note that STATISTICS and all its indentions are treed under  
EPIDEMIOLOGIC METHODS in Category E5;  that means that the statistical terms  
must also be indexed even if only mentioned.  However, it is quite common for  
researchers to mention the use of more than three statistical methods, so it is  
quite likely that the general term STATISTICS will be the heading indexed to  
cover all the statistical methods mentioned. 
  
			Mortality in AIDS; a prospective study. 
			(Statistical methods mentioned in the paragraph on statistics  
include odds ratio, proportional hazards models, least-squares analysis, and  
analysis of variance;  confidence intervals are given.  A MeSH heading is  
available for each of these methods, but the only term under which all are treed  
is STATISTICS.) 
				AIDS / * mortal  
				PROSPECTIVE STUDIES 
				STATISTICS 
 

26.27.2	Although the epidemiologic method or concept must be indexed even if  
merely mentioned, make sure that the article is actually about an epidemiologic  
concept.  
			Prevalence of c-erbB-2 protein in breast neoplasms. 
				BREAST NEOPLASMS / * chem 
				PROTO-ONCOGENE PROTEINS C-ERBB-2 / * anal 
				Not:  PREVALENCE 
 

26.27.3	Epidemiologic methods do not need to be indexed when they are  
mentioned by an author but only in relation to other studies (for example, in  
the introduction or discussion section of the article).  The rule applies only  
to mention of methods used in the study being indexed. 
 

26.27.4	Epidemiologic and statistical methods also do not need to be indexed  
for mere mention in studies performed in laboratory animals.  These studies are  
not epidemiologic in nature, and epidemiologists do not want to retrieve them.   
In preclinical journals, epidemiologic and statistical methods need to be  
indexed only if substantively discussed or in the title or statement of purpose,  
as with any other research technique. 
 

26.28		Dentistry includes a varied collection of clinical, laboratory, and   
epidemiological techniques relating to the stomatognathic system    and its  
disorders.  Of the clinical techniques, those which approach the tooth directly,  
however invasive, are usually considered to be therapeutic, while those that  
require incision into the underlying structures are generally considered to be  
surgical.  But the distinction is a fine one, and there is considerable overlap. 
 

26.28.1	ANESTHESIA, DENTAL encompasses a broad range of techniques ranging  
from those used in uncomplicated dental restoration to those used in  
stomatognathic surgery.  It is therefore essential that the specific type of  
anesthesia be accounted for in the indexing.ing. 
 
			Conscious sedation for dental procedures in the 
			anxious patient. 
				* ANESTHESIA, DENTAL 
				* CONSCIOUS SEDATION 
				DENTAL ANXIETY / * prev 
				HUMAN (check tag) 
 

26.28.2	ACID ETCHING, DENTAL is defined by MeSH as "the pretreatment of  
tooth surfaces with etching agents to increase the adhesion of resin systems."   
Indexers should restrict its use to the etching of the dental tissue even though  
authors use the expression "acid etching" for the etching of materials.  
 
			Effect of etching time on resin-enamel bond strength. 
				ACID ETCHING, DENTAL / * methods 
				* COMPOSITE RESINS 
				* DENTAL ENAMEL 
				TIME FACTORS 
				TENSILE STRENGTH 
			      Not:  DENTAL BONDING because ACID ETCHING, DENTAL  
			      is indented under DENTAL BONDING 
 
		DENTAL BONDING should, however, be used for acid etching of the  
materials. 
 
			Hydrochloric acid etching of nickel-chromium frameworks for  
	adhesive bridges. 
				DENTAL BONDING / * methods 
				* HYDROCHLORIC ACID 
				* DENTURE, PARTIAL, FIXED, RESIN-BONDED 
				* CHROMIUM ALLOYS 
			      Not:  ACID ETCHING, DENTAL because it is a synthetic  
material that is etched 
 

26.28.3	A careful distinction should be made between DENTAL CARE FOR  
DISABLED and DENTAL CARE FOR CHRONICALLY ILL.  Both are covered by the Americans  
with Disabilities Act, but the emphasis is apt to be different.  Articles on  
DENTAL CARE FOR DISABLED tend to discuss the accessibility of dental care to  
disabled persons. Articles on DENTAL CARE FOR CHRONICALLY ILL tend to discuss  
the possible infectiousness of the patient, the interactions of dental  
medicaments with drugs the patient may be taking, and, in general, what the  
dentist should know about the pre-existing disease before treating the patient. 
 
			Dental procedures and the floppy mitral valve--an 
			ounce of prevention. 
				ENDOCARDITIS, BACTERIAL / * prev 
				* ANTIBIOTIC PROPHYLAXIS 
				* DENTAL CARE FOR CHRONICALLY ILL 
				* MITRAL VALVE PROLAPSE 
 
			From the wheelchair to the dentist's chair--a 
			simple portable lifting device for use with  
			quadriplegic patients. 
				DENTAL CARE FOR DISABLED / *instrum    
				* QUADRIPLEGIA 
				* DENTAL EQUIPMENT 
				EQUIPMENT DESIGN 
 

26.28.3.1	The headings DENTAL CARE FOR AGED and DENTAL CARE FOR CHILDREN can  
be used for all aspects of dental treatment or treatment needs among these  
population groups. 
 
			Treating aphthous ulcers in young children. 
				STOMATITIS, APHTHOUS / * drug ther 
				* DENTAL CARE FOR CHILDREN 
				CHILD, PRESCHOOL (check tag) 
				HUMAN (check tag) 
				Not:  PEDIATRIC DENTISTRY because that refers to 
				the field 
 

26.28.4	DENTAL EQUIPMENT and DENTAL INSTRUMENTS differ in that instruments  
not only can be held in the hand but must be powered by the hand, not merely  
guided by the hand although powered by floor-mounted equipment.  Dental  
equipment includes chairs, trollies, curing lamps, water supply lines, etc.; but  
"dental handpieces" (which are designed to be used as attachments to free- 
standing equipment and which operate at speeds above 12,000 rpm) are indexed as  
DENTAL HIGH-SPEED EQUIPMENT. 
 

26.28.4.1	Indexers should not use DENTAL INSTRUMENTS if the subheading 
		/ instrumentation can be used with a dental procedure or specialty. 
			A new ultrasonic periodontal probe. 
				PERIODONTICS / * instrum 
				ULTRASONIC THERAPY / * instrum 
 

26.28.5	The heading DENTAL HEALTH SURVEYS should be used as IM only for  
articles on large-scale surveys on almost every aspect of dental health or for  
articles on how to conduct a dental health survey.  Most articles entitled  
"Survey of dental health in ..." actually deal with the prevalence of specific  
diseases and should be indexed for those diseases with the subheading /  
epidemiology.  DENTAL HEALTH SURVEYS or one of its indentions may be indexed NIM  
to satisfy the requirement that statistical concepts be covered. 
 

26.28.5.1	The specific terms indented under DENTAL HEALTH SURVEYS may be used  
for either population studies or individual studies. 
 
 

26.28.6	DENTAL MODELS are physical models of teeth and supporting  
structures.  This heading is never used for theoretical models. 
 
			Arch length considerations due to the curve of Spee: a  
			mathematical model.  (The curve of Spee is the curvature 
			of the occlusal alignment of teeth.) 
				DENTAL ARCH / * anat 
				* DENTAL OCCLUSION 
				* MODELS, BIOLOGICAL 
			      Not:  DENTAL MODELS 
 

26.28.6.1	The indexer should be aware that authors often use the terms "dental  
casts" and "dental models" interchangeably. 
 
			The accuracy of gypsum casts. 
				* DENTAL MODELS 
				* CALCIUM SULFATE 
				 REPRODUCIBILITY OF RESULTS 
				Not:  DENTAL CASTING TECHNIQUE 
 
			The influence of sprue design on cobalt-chromium 
			alloy casting defects. 
				* CHROMIUM ALLOYS 
				* DENTAL CASTING INVESTMENT 
				DENTAL CASTING TECHNIQUE / * instrum 
				EQUIPMENT DESIGN 
 

26.28.6.2	Discussions of the physical forces in dental function often include  
mathematical analysis and are usually indexed as DENTAL STRESS ANALYSIS.   
Indexers should prefer this to BIOMECHANICS, since DENTAL STRESS ANALYSIS is  
more specifically related to dentistry.  
 
			Distribution of stress levels and profiles in the periodontal  
ligament during the application of orthodontic forces. 
				* DENTAL STRESS ANALYSIS 
				PERIODONTAL LIGAMENT / * physiol 
				* ORTHODONTICS, CORRECTIVE 
 

26.28.7	DENTAL OCCLUSION refers to the relationship of the maxilla and  
mandible when in the closed position.  There are many devices and methods for  
analysing occlusion but very few of these are MeSH terms, and therefore these  
concepts must often be indexed as 
		JAW RELATION RECORD with the subheadings / methods or 
		/ instrumentation. 
 
			Computerized occlusal analysis. 
				* DENTAL OCCLUSION 
				JAW RELATION RECORD / * methods 
				* IMAGE PROCESSING, COMPUTER-ASSISTED 
 
			Axiography in the diagnosis of TMJ disorders. 
				TEMPOROMANDIBULAR JOINT DISEASES / * diag 
				JAW RELATION RECORD / * instrum 
 

26.28.7.1	More extensive recording of craniofacial reference points is  
CEPHALOMETRY.  This term is not included in the E6 category.  However, dental  
articles often contain diagrams of facial angles and other landmarks, which are  
indexed as CEPHALOMETRY (usually NIM). 
 

26.28.8	DENTAL POLISHING (per MeSH scope note) is used only for the  
polishing or "finishing" of dentures or dental materials.  "Polishing" of  
natural teeth is DENTAL PROPHYLAXIS or TOOTHBRUSHING. 
 

26.28.8.1	Similarly, authors often speak of "abrasive therapy" when referring  
to the polishing of superficially discolored teeth with abrasive dentifrices.   
The indexer must remember that TOOTH ABRASION is a disease term in C7 and cannot  
be used for a therapy.  Abrasive therapy is indexed as ENAMEL MICROABRASION. 
 

26.28.9	DENTISTRY, OPERATIVE is the field concerned with procedures designed  
to restore or reform the hard tissues of teeth (enamel, dentin,  cementum).   
SURGERY, ORAL is the specialty that deals with surgery of the mouth and jaws.   
ORAL SURGICAL PROCEDURES are surgical procedures used to treat disease, injuries  
and defects of the oral and maxillofacial region. Operative dentistry is not  
usually considered as part of surgery. 
 
			Laser cavity preparation. 
				DENTAL CAVITY PREPARATION / * instrum 
				* LASERS 
			      Not:  LASER SURGERY 
 
			Lasers in soft tissue oral surgery: gingiva and buccal mucosa. 
				ORAL SURGICAL PROCEDURES / * instrum 
				* LASER SURGERY 
				GINGIVA / * surg 
				MOUTH MUCOSA / * surg 
				CHEEK / surg 
 
			Advanced training in maxillofacial surgery. 
				* EDUCATION, DENTAL, GRADUATE 
				SURGERY, ORAL / * educ 
 

26.28.9.1	Indexers should be aware that the word "restoration" can be used  
narrowly to refer to "fillings" or inlays or broadly to refer to any prosthetic  
restoration of lost tooth structure or teeth, including crowns, dentures, or  
implants, and can thus be used as a synonym for "prosthesis."  This ambiguity  
can be especially confusing if the article is written in a foreign language with  
an author-supplied title translation. 
 
			Implantgetragener Zahnersatz. 
			[Implant-supported restorations] 
				* DENTAL PROSTHESIS, IMPLANT-SUPPORTED 
				* DENTURE, OVERLAY 
				  Not:  DENTAL RESTORATION, PERMANENT 
 
		The MeSH term DENTAL RESTORATION FAILURE can thus be used for the  
failure of any dental prosthesis and is usually IM. 
 
			Surgical management of peri-implantitis due to  
			implant failure. 
				DENTAL IMPLANTS / *adv eff 
				PERIODONTITIS / * etiol / *surg 
				* DENTAL RESTORATION FAILURE 
				Not:  PROSTHESIS FAILURE  
				 

26.28.10	The area of endodontics includes a number of possibly confusing  
headings. 
 

26.28.10.1	APICOECTOMY refers to "root tip amputation."  It is not a synonym    
for surgery of the tooth root. 
 

26.28.10.2	Root canal therapy may be direct, i.e., approached from the tooth  
crown, or it may be retrograde, i.e., approached through the alveolar bone.  The  
appropriate subheading coordination for directly approached ROOT CANAL  
OBTURATION is /therapy; the subheading used with the organ or disease term in  
RETROGRADE OBTURATION is /surg. 
 

26.28.11	Most of the headings in the area of orthodontics are fairly self- 
evident.  A few exceptions will be noted. 
 

26.28.11.1	ORTHODONTICS refers to the field.  Orthodontic treatment is  
ORTHODONTICS, CORRECTIVE unless specified as ORTHODONTICS, INTERCEPTIVE or  
ORTHODONTICS, PREVENTIVE. 
 
			Can orthodontics cause TMJ disorders? 
				TEMPOROMANDIBULAR JOINT DISORDERS / * etiol 
				ORTHODONTICS, CORRECTIVE / * adv eff 
 

26.28.11.2	Authors often use the words "tooth movement" when referring to the  
entire spectrum of physiological and biomechanical processes that go on when  
orthodontic forces are applied to bones and teeth. 
			Alveolar bone remodeling in orthodontic tooth movement. 
				* TOOTH MOVEMENT 
				ALVEOLAR PROCESS / * physiol 
				* BONE REMODELING 
 
 
		Indexers should take care to distinguish orthodontic tooth movement  
from TOOTH MIGRATION and TOOTH MOBILITY, i.e., physiologic and pathologic tooth  
movement in Categories G and C.  The movement of teeth into altered positions  
along the line of the dental arch is TOOTH MIGRATION.  It may be due to  
pathologic changes in the tooth supporting structures, or it may occur as part  
of the natural processes of growth.  The movement of a tooth in its socket is  
TOOTH MOBILITY.  Excessive mobility is generally the result of periodontal  
disease, but the mobility of deciduous teeth prior to exfoliation is normal.   
Also normal is tooth mobility within the elastic limits of the supporting tissue  
in response to occlusal forces. 
 
			Dental drift in the maturing maxilla. 
				* TOOTH MIGRATION 
				MAXILLA / * growth 
 
			Tooth mobility and bone loss--"Periotest" results and  
radiologic correlations in mandibular atrophy. 
				TOOTH MOBILITY / * diag 
				ALVEOLAR BONE LOSS / * radiogr 
				MANDIBULAR DISEASES / * radiogr 
 

26.28.11.3	TOOTH MOVEMENT refers to orthodontic techniques used to correct  
tooth malposition.  It implies orthodontic movement of one or more teeth, but  
not of a whole section of the dental arch.  Terms frequently encountered are  
"intrusion," "extrusion," and "uprighting." 
 

26.28.12	In the area of periodontics, the indexer should note that GUIDED  
TISSUE REGENERATION is a surgical technique and that it is treed in E6 only and  
not also in G4.  It is not therefore redundant to index both the technique and  
the physiology. 
			Regeneration of alveolar infrabony defects using GTR. 
				* GUIDED TISSUE REGENERATION 
				* BONE REGENERATION 
				ALVEOLAR BONE LOSS / * surg 
				 
			Periodontal ligament regeneration using resorbable  
			collagen membranes. 
				PERIODONTAL LIGAMENT / * physiol 
				* REGENERATION 
			      GUIDED TISSUE REGENERATION / * methods 
				* COLLAGEN 
 
		If the membrane used is an ordinary nonresorbable one that requires  
removal, it is not necessary to add MEMBRANES, ARTIFICIAL routinely, since this  
is implied in the concept of guided tissue regeneration. 
 
 

26.28.13	Prosthodontics is the dental specialty concerned with the  
replacement of teeth and contiguous structures with artificial substitutes.  It  
includes implants, dentures, implant-denture combinations, and replacements for  
single teeth as well as parts of teeth. 
 

26.28.13.1	The term DENTURES and its indentions should be used for conventional  
full or partial replacements for upper or lower teeth and contiguous structures.   
In the case of complete dentures MeSH provides separate terms for upper and  
lower dentures.  In the case of partial dentures ("bridges") the indexer must  
supply the location, usually NIM. 
 
			Cingulum bar as a major connector for mandibular removable  
partial dentures. 
				* DENTURE, PARTIAL, REMOVABLE 
				DENTURE RETENTION / * instrum 
				MANDIBLE 
 

26.28.13.2	A dental prosthesis may be more or less inclusive than a denture.  A  
single CROWN is a dental prosthesis; the combination of a denture and the  
implant that supports it is a DENTAL PROSTHESIS.  Note that the MeSH term CROWNS  
always refers to a prosthetic crown, never to the anatomical crown of the tooth  
(= TOOTH CROWN). 
 
		In practice, the indexer must often use both prosthesis terms and  
denture terms to index an article completely. 
 
			Implant-supported overdentures for the edentulous maxilla. 
				* DENTAL PROSTHESIS, IMPLANT-SUPPORTED 
				* DENTURE, OVERLAY 
				JAW, EDENTULOUS / * rehabil 
				MAXILLA 
 
			A unique method of combining abutment teeth and endosseous  
implants for a stable removable prosthesis. 
				* DENTAL PROSTHESIS, IMPLANT-SUPPORTED 
				DENTAL IMPLANTATION, ENDOSSEOUS / * methods 
				* DENTAL PROSTHESIS DESIGN 
				* DENTURE, PARTIAL, REMOVABLE 
				* DENTAL ABUTMENTS 
 
		Note that the term DENTAL ABUTMENTS includes any structure used as  
an anchorage for a dental prosthesis.  The term appears in MeSH only in the E6  
category, but a natural tooth can serve as an abutment and should be so indexed. 
 

26.28.13.3	The use of implants has given rise to a number of new preprosthetic  
surgical techniques.  One of the most frequently discussed is ALVEOLAR RIDGE  
AUGMENTATION, since endosseous implants require sufficient bone structure to  
retain them and the edentulous jaw is apt to have suffered severe bone  
resorption. 
 
			Augmentation of the alveolar ridge with hydroxylapatite. 
				ALVEOLAR RIDGE AUGMENTATION / * methods 
				* DURAPATITE 
				* BONE SUBSTITUTES 
 
 
		Another common pre-implant technique is the "sinus lift procedure,"  
in which the surgery is done on the floor of the maxillary sinus rather than on  
the alveolar ridge. 
 
			Sinus lift grafts and endosseous implants. 
				ORAL SURGICAL PROCEDURES, PREPROSTHETIC / * methods 
				MAXILLARY SINUS / * surg 
				BONE TRANSPLANTATION / * methods 
				DENTAL IMPLANTATION, ENDOSSEOUS / * methods 
				*DENTAL IMPLANTS