Chabner Lom Ch. 15 Musculoskeletal System

Front 1

acetabulum

Back 1

Rounded depression, or socket, in the pelvic bone where the femur (thigh bone) joins the pelvis, forming the hip joint.

Front 2

acromion

Back 2

Outward extension of the shoulder bone forming the point of the shoulder. It overlies the shoulder joint and articulates with the clavicle.

Front 3

articular cartilage

Back 3

Thin layer of cartilage occurring at the ends of long bones and covering any part of bone that comes together with another bone to form a joint.

Front 4

calcium

Back 4

One of the mineral constituents of bone. Calcium phosphate is the major calcium salt in bones.

Front 5

cancellous bone

Back 5

Spongy, porous, trabecular bone.

Front 6

cartiliginous tissue (cartilage)

Back 6

Flexible, rubbery connective tissue. It is found on joint surfaces throughout life and in the immature skeleton at the epiphyseal growth plate.

Front 7

collagen

Back 7

Dense connective tissue strands found in bone.

Front 8

compact bone

Back 8

Hard, dense bone tissue.

Front 9

condyle

Back 9

Knuckle-like process at the end of a bone near the joint.

Front 10

cranial bones

Back 10

skull bones: ethmoid, frontal, occipital, parietal, sphenoid, and temporal.

Front 11

diaphysis

Back 11

Shaft, or midportion, of a long bone.

Front 12

epiphyseal plate

Back 12

Cartiliginous area at the ends of long bones where lengthwise growth takes place.

Front 13

epiphysis

Back 13

Each end of a long bone; the area beyond the epiphyseal plate.

Front 14

facial bones

Back 14

lacrimal, mandible, maxillae, nasal, vomer, and zygomatic bones.

Front 15

fontanelle

Back 15

Soft spot (incomplete formation) between the skull bones of an infant.

Front 16

foramen

Back 16

Opening or passage in bones where blood vessels, nerves, or both enter and leave. The foramen magnum is the opening of the occipital bone through which the spinal cord passes.

Front 17

fossa

Back 17

Shallow cavity in a bone.

Front 18

haversian canals

Back 18

Minute spaces filled with blood vessels; found in compact bone.

Front 19

malleolus

Back 19

Round process on both sides of the ankle joint. The lateral malleolus is part of the fibula, and the medial malleolus is part of the tibia.

Front 20

mastoid process

Back 20

Round projection on the temporal bone behind the ear.

Front 21

medullary cavity

Back 21

Central, hollowed-out area in the shaft of a long bone.

Front 22

metaphysis

Back 22

The flared portion of a long bone, lying between the diaphysis (shaft) and the epiphyseal plate (meta- means between).

Front 23

olecranon

Back 23

Large process on the proximal end of the ulna; the point of the flexed elbow.

Front 24

osseous tissue

Back 24

Bone tissue.

Front 25

ossification

Back 25

Process of bone formation.

Front 26

osteoblast

Back 26

bone cell that helps form bone tissue.

Front 27

osteoclast

Back 27

Bone cell that absorbs and removes unwanted bone tissue.

Front 28

periosteum

Back 28

Membrane surrounding bones; rich in blood vessels and nerve tissue.

Front 29

phosphorus

Back 29

mineral substance found in bones in combination with calcium.

Front 30

pubic symphysis

Back 30

Area of confluence (coming together) of the two pubic bones. They are joined (sym- means together, -physis means to grow)by a fibrocartilaginous disc.

Front 31

red bone marrow

Back 31

Found in cancellous bone; site of hematopoiesis.

Front 32

ribs

Back 32

These 24 elongated, curved bones form the bony wall of the chest. True ribs are the first 7 pairs; false ribs are pairs 8-10; floating ribs are pairs 11 and 12.

Front 33

sinus

Back 33

Cavity within a bone.

Front 34

styloid process

Back 34

Pole-like process on the temporal bone.

Front 35

trabeculae

Back 35

Supporting bundles of bony fibers in cancellous (spongy) bone.

Front 36

trochanter

Back 36

Large process below the neck of the femur; attachment site for muscles and tendons.

Front 37

tubercle

Back 37

Small, rounded process on a bone; attachment site for muscles and tendons.

Front 38

tuberosity

Back 38

Large, rounded process on a bone; attachment site for muscles and tendons.

Front 39

vertebra

Back 39

individual back bone composed of the vertebral body, vertebral arch, spinous process, transverse process, lamina, and neural canal.

Front 40

xiphoid process

Back 40

Lower, narrow portion of the sternum.

Front 41

yellow bone marrow

Back 41

Fatty tissue found in the diaphyses of long bones.

Front 42

calc/o

Back 42

calcium

Front 43

calci/o

Back 43

calcium

Front 44

kyph/o

Back 44

humpback (posterior curvature in the thoracic region)

Front 45

lamin/o

Back 45

lamina (part of the vertebral arch)

Front 46

lord/o

Back 46

curve, swayback (anterior curvature in the lumbar region)

Front 47

lumb/o

Back 47

loins, lower back

Front 48

myel/o

Back 48

bone marrow

Front 49

orth/o

Back 49

straight

Front 50

oste/o

Back 50

bone

Front 51

scoli/o

Back 51

crooked, bent (lateral curvature)

Front 52

spondyl/o

Back 52

vertebra (used to make words about conditions of the structure)

Front 53

vertebr/o

Back 53

vertebra (used to describe the structure)

Front 54

-blast

Back 54

embryonic or immature cell

Front 55

-clast

Back 55

to break

Front 56

-listhesis

Back 56

slipping

Front 57

-malacia

Back 57

softening

Front 58

-physis

Back 58

to grow

Front 59

-porosis

Back 59

pore, passage

Front 60

-tome

Back 60

instrument to cut

Front 61

acetabul/o

Back 61

acetabulum (hip socket)

Front 62

calcane/o

Back 62

calcaneus (heel bone)

Front 63

carp/o

Back 63

carpals (wrist bones)

Front 64

clavicul/o

Back 64

calvicle (collar bone)

Front 65

cost/o

Back 65

ribs (true ribs, false ribs, and floating ribs)

Front 66

crani/o

Back 66

cranium (skull)

Front 67

femor/o

Back 67

femur (thigh bone)

Front 68

fibul/o

Back 68

fibula (smaller lower leg bone)

Front 69

humer/o

Back 69

humerus (upper arm bone)

Front 70

ili/o

Back 70

ilium (upper part of the pelvic bone)

Front 71

isch/o

Back 71

ischium (posterior part of the pelvic bone)

Front 72

mandibul/o

Back 72

mandible (lower jaw bone)

Front 73

maxill/o

Back 73

maxilla (upper jaw bone)

Front 74

metacarp/o

Back 74

metacarpals (hand bones)

Front 75

metatars/o

Back 75

metatarsals (foot bones)

Front 76

olecran/o

Back 76

olecranon (elbow)

Front 77

patell/o

Back 77

patella (kneecap)

Front 78

pelv/i

Back 78

pelvis (hip bone)

Front 79

perone/o

Back 79

fibula (smaller lower leg bone)

Front 80

phalang/o

Back 80

phalanges (finger bones)

Front 81

pub/o

Back 81

pubis (anterior part of the pelvic bone)

Front 82

radi/o

Back 82

radius (lower arm bone - thumb side)

Front 83

scapul/o

Back 83

scapula (shoulder bone)

Front 84

stern/o

Back 84

sternum (breast bone)

Front 85

tars/o

Back 85

tarsals (bones of the hindfoot)

Front 86

tibi/o

Back 86

tibia (shin bone)

Front 87

uln/o

Back 87

ulna (lower arm bone - little finger side)

Front 88

Ewing sarcoma

Back 88

Malignant bone tumor.

Front 89

exostosis

Back 89

Bony growth arising from the surface of bone, such as osteochondromas and bunions.

Front 90

bunion

Back 90

A swelling of the metatarsophalangeal joint near the base of the big toe and is accompanied by the build-up of soft tissue and underlying bone.

Front 91

Colles fracture

Back 91

occurs near the wrist joint at the lower end of the radius.

Front 92

comminuted fracture

Back 92

bone is splintered or crushed into several pieces. A simple fracture means that a bone breaks in only one place and is therefore not comminuted.

Front 93

compression fracture

Back 93

bone is compressed; often occurs in vertebrae.

Front 94

impacted fracture

Back 94

fracture in which one fragment is driven firmly into the other.

Front 95

osteogenic sarcoma

Back 95

Malignant tumor arising from bone (osteosarcoma). This is the most common type of malignant bone tumor.

Front 96

osteomalacia

Back 96

Softening of bone, with inadequate amounts of mineral (calcium) in the bone.

Front 97

osteomyelitis

Back 97

Inflammation of the bone and bone marrow secondary to infection.

Front 98

osteoporosis

Back 98

Decrease in bone density (mass); thinning and weakening of bone.

Front 99

talipes

Back 99

Congenital abnormality of the hindfoot (involving the talus). Ex: talipes equinovarus, or clubfoot. In this congenital deformity, the patient cannot stand with the sole of the foot flat on the ground.

Front 100

articulation

Back 100

joint

Front 101

bursa (plural: bursae)

Back 101

Sac of fluid near a joint; promotes smooth sliding of one tissue against another.

Front 102

ligament

Back 102

Connective tissue binding bones to other bones; supports, strengthens, and stabilizes the joint.

Front 103

suture joint

Back 103

Type of joint in which apposed surfaces are closely united.

Front 104

synovial cavity

Back 104

Space between bones at a synovial joint; contains synovial fluid produced by the synovial membrane.

Front 105

synovial fluid

Back 105

Viscous (sticky) fluid within the synovial cavity.

Front 106

synovial joint

Back 106

A freely movable joint.

Front 107

synovial membrane

Back 107

Membrane lining the synovial cavity; it produces synovial fluid.

Front 108

tendon

Back 108

Connective tissue that binds muscles to bones.

Front 109

ankyl/o

Back 109

crooked, bent, stiff

Front 110

arthr/o

Back 110

joint

Front 111

articul/o

Back 111

joint

Front 112

burs/o

Back 112

bursa

Front 113

chondr/o

Back 113

cartilage

Front 114

ligament/o

Back 114

ligament

Front 115

rheumat/o

Back 115

watery flow

Front 116

synov/o

Back 116

synovial membrane

Front 117

ten/o

Back 117

tendon

Front 118

tendin/o

Back 118

tendon

Front 119

-desis

Back 119

to bind, tie together

Front 120

-stenosis

Back 120

narrowing

Front 121

arthritis

Back 121

inflammation of joints.

Front 122

ankylosing spondylitis

Back 122

Chronic, progressive arthritis with stiffening of joints, primarily of the spine.

Front 123

gouty arthritis

Back 123

Inflammation of joints caused by excessive uric acid in the body.

Front 124

osteoarthritis

Back 124

Progressive, degenerative joint disease characterized by loss of articular cartilage and hypertrophy of bone (formation of osteophytes or bone spurs) at articular surfaces.

Front 125

rheumatoid arthritis

Back 125

A chronic disease in which joints become inflamed and painful. It is believed to be caused by an immune (autoimmune) reaction against joint tissues, particularly against the synovial membrane.

Front 126

Carpal Tunnel Syndrome (CTS)

Back 126

Compression (by a wrist ligament) of the median nerve as it passes between the ligament and the bones and tendons of the wrist (the carpal tunnel).

Front 127

dislocation

Back 127

Displacement of a bone from its joint.

Front 128

ganglion

Back 128

A fluid-filled cyst arising from the joint capsule or a tendon in the wrist.

Front 129

Lyme disease

Back 129

A recurrent disorder marked by severe arthritis, myalgia, malaise, and neurologic and cardiac symptoms.

Front 130

sprain

Back 130

Trauma to a joint with pain, swelling, and injury to ligaments.

Front 131

systemic lupus erythmatosus (SLE)

Back 131

Chronic inflammatory disease involving joints, skin, kidneys, nervous system, heart, and lungs.

Front 132

abduction

Back 132

Movement away from the midline of the body.

Front 133

adduction

Back 133

Movement toward the midline of the body.

Front 134

dorsiflexion

Back 134

Backward (upward) bending of the foot.

Front 135

extension

Back 135

Straightening of a flexed limb.

Front 136

fascia

Back 136

Fibrous membrane separating and enveloping muscles.

Front 137

flexion

Back 137

Bending

Front 138

plantar flexion

Back 138

Bending the sole of the foot downward toward the ground.

Front 139

pronation

Back 139

Turning the palm backward.

Front 140

rotation

Back 140

Circular movement around a central point.

Front 141

skeletal muscle

Back 141

Muscle connected to bones; voluntary or striated muscle.

Front 142

smooth muscle

Back 142

Muscle connected to internal organs; involuntary or visceral muscle.

Front 143

striated muscle

Back 143

skeletal muscle

Front 144

supination

Back 144

Turning the palm forward.

Front 145

visceral muscle

Back 145

smooth muscle

Front 146

fasci/o

Back 146

fascia (forms sheaths enveloping muscles)

Front 147

fibr/o

Back 147

fibrous connective tissue

Front 148

leiomy/o

Back 148

smooth (visceral) muscle that lines the walls of internal organs.

Front 149

my/o

Back 149

muscle

Front 150

myocardi/o

Back 150

heart muscle

Front 151

myos/o

Back 151

muscle

Front 152

plant/o

Back 152

sole of the foot

Front 153

rhabdomy/o

Back 153

skeletal (striated) muscle connected to bones.

Front 154

-asthenia

Back 154

lack of strength

Front 155

-trophy

Back 155

development, nourishment

Front 156

ab-

Back 156

away from

Front 157

duct/o

Back 157

to lead

Front 158

ad-

Back 158

toward

Front 159

dorsi-

Back 159

back

Front 160

poly-

Back 160

many, much

Front 161

muscular dystrophy

Back 161

A group of inherited diseases characterized by progressive weakness and degeneration of muscle fibers without involvement of the nervous system.

Front 162

polymyositis

Back 162

Chronic inflammatory myopathy.

Front 163

anitnuclear antibody test (ANA)

Back 163

A sample of plasma is tested for the presence of antibodies that are found in patients with systemic lupus erythematosus.

Front 164

erythrocyte sedimentation rate (ESR)

Back 164

This test measures the rate at which erythrocytes fall to the bottom of a test tube. Elevated sedimentation rates are associated with inflammatory disorders such as rheumatoid arthritis.

Front 165

rheumatoid factor test

Back 165

A sample of blood is tested for the presence of the rheumatoid factor (an antibody found in the serum of patients with rheumatoid arthritis).

Front 166

serum calcium (Ca)

Back 166

Measurement of the amount of calcium in blood (serum).

Front 167

serum creatine phosphokinase (CPK)

Back 167

Creatine phosphokinase is an enzyme normally present in skeletal and cardiac muscle. Elevated serum CPK levels are found in muscular dystrophy, myocardial infarction, and skeletal muscle disorders.

Front 168

serum phosphorus (P)

Back 168

Measurement of the amount of phosphorus in a sample of serum.

Front 169

uric acid test

Back 169

This test measures the amount of uric acid in a sample of blood. High values are associated with gouty arthritis.

Front 170

arthrocentesis

Back 170

Surgical puncture of the joint space with a needle. Synovial fluid is removed for analysis.

Front 171

arthrography

Back 171

Process of taking x-ray pictures of a joint after injection of opaque contrast material.

Front 172

arthroplasty

Back 172

Surgical repair of a joint.

Front 173

arthroscopy

Back 173

Visual examination of the inside of a joint with an endoscope. Small surgical instruments are passed into the joint to remove and repair damaged tissue. Arthroscopy is used primarily to visualize the knee, ankle, and shoulder.

Front 174

bone scan

Back 174

A radioactive phosphate substance is injected intravenously, and uptake of the substance in bone is measured by a special scanning device. Areas that take up excessive amounts of radioactive substance may contain tumors, infection, inflammation, stress fractures or other destructive changes.

Front 175

electromyography (EMG)

Back 175

The process of recording the strength of muscle contraction as a result of electrical stimulation.

Front 176

muscle biopsy

Back 176

removal of muscle tissue for microscopic examination.

Front 177

calcaneal
596

Back 177

pertaining to calcaneus

Front 178

calcaneus
596

Back 178

tarsal (hindfoot) bones

Front 179

carpals
596

Back 179

pertaining to the carpals

Front 180

cervical vertebrae
586

Back 180

first seven bones of the vertebrae

Front 181

chondrocostal
597

Back 181

pertaining to the rib cartilage

Front 182

clavicle
596

Back 182

pertaining to the above the clavicles

Front 183

coccyx
587

Back 183

the tailbone

Front 184

craniotome
597

Back 184

instrument to cut the cranium

Front 185

craniotomy
597

Back 185

process of cutting the cranium

Front 186

decalcification
594

Back 186

process of making less calcium

Front 187

ethmoid bone 583

Back 187

thin bone that extends behind the eyes and forms part of the base of the skull

Front 188

femoral 597

Back 188

pertaining to the femur

Front 189

femur 597

Back 189

thigh bone

Front 190

fibula 597

Back 190

smaller lower leg bone

Front 191

fibular 597

Back 191

pertaining to the fibula

Front 192

fissure 592

Back 192

narrow, slit-like opening in or between bones

Front 193

frontal bone 582

Back 193

forms the forehead and the roof of the bony sockets that contain the eyes

Front 194

humeral 597

Back 194

pertaining to the humerous

Front 195

humerus 597

Back 195

upper arm bone

Front 196

hypercalcemia
594

Back 196

blood condition of excessive calcium

Front 197

illiac 597

Back 197

upper part of the pelvic bone

Front 198

ischial 597

Back 198

pertaining to the ischium

Front 199

ischium 597

Back 199

posterior part of the pelvic bone

Front 200

kyphosis 594

Back 200

condition of humpback

Front 201

lacrimal bones 584

Back 201

the two small thin bones located at the corner of each eye

Front 202

lamina 594

Back 202

part of the vertebral arch

Front 203

laminectomy 594

Back 203

removal of the lamina

Front 204

lordosis 594

Back 204

condition of curve

Front 205

lumbar vertebrae
587

Back 205

third set of vertebral bones

Front 206

lumbosacral 595

Back 206

pertaining to the lower back and sacral

Front 207

malleolar
597

Back 207

pertaining to the malleolus

Front 208

mandible
597

Back 208

lower jaw bone

Front 209

manubrium 593

Back 209

upper portion of the sternum

Front 210

metecarpectomy 597

Back 210

removal of the metacarpals

Front 211

metacarpals 589

Back 211

hand bones

Front 212

metatarsalgia 597

Back 212

pertaining to the metatarsals

Front 213

metatarsals 591

Back 213

foot bones

Front 214

myelopoiesis 595

Back 214

formation of bone marrow

Front 215

nasal bones 584

Back 215

two slender bones that support the bridge of the nose

Front 216

occipital bone 583

Back 216

forms the back and bass of the skull and joins the parietal and temporal bones

Front 217

olecranon 589

Back 217

elbow bone

Front 218

orthopedics 595

Back 218

pertaining to straight child

Front 219

osteitis 595

Back 219

inflammation of the bone

Front 220

osteodystrophy 595

Back 220

abnormal development of the bone

Front 221

osteogenesis imperfeta 5959

Back 221

genetic disorder involving defective development of bones that are brittle and fragile

Front 222

osteotome 596

Back 222

instrument to cut bones

Front 223

parietal bone 582

Back 223

the two bones that forms the roof and upper part of the sides of the cranium

Front 224

patella 591

Back 224

the kneecap

Front 225

pelvimetry 597

Back 225

measurement of the pelvis

Front 226

periosteum 593

Back 226

membrane surround bones

Front 227

peroneal 597

Back 227

pertaining to the fibula

Front 228

phalangeal 597

Back 228

pertaining to the phalanges

Front 229

phalanges 590

Back 229

finger bones/or toe bones

Front 230

pubis 590

Back 230

anterior part of the pelvic bone

Front 231

radial 598

Back 231

pertaining to the radius

Front 232

radius 589

Back 232

lateral lower arm bone

Front 233

reduction 599

Back 233

restoration of the bone to its normal position

Front 234

sacral vertebrae 587

Back 234

five separate bones that fuse in a young child

Front 235

scapula 598

Back 235

shoulder blade

Front 236

scapular 598

Back 236

pertaining to the scapula

Front 237

scoliosis 595

Back 237

crooked condition

Front 238

sella turcica 598

Back 238

a depression in the sphenoid bone, containing the pituitary gland.

Front 239

sphenoid bone 583

Back 239

the bat-shaped bone that extends behind the eyes and forms part of the base of the skull

Front 240

spondylolisthesis 596

Back 240

slipping vertebrae

Front 241

spondylosis 596

Back 241

condition of vertebrae

Front 242

sternum 598

Back 242

breast bone

Front 243

subcostal 597

Back 243

pertaining to below the ribs

Front 244

supraclavicular 596

Back 244

pertaining to above the clavicles

Front 245

suture 593

Back 245

immovable joint between bones, such as the skull

Front 246

tarsal 598

Back 246

bones of the hind foot

Front 247

tarsectomy
598

Back 247

resection of the tarsals

Front 248

temporal bone 583

Back 248

the two bones that form the lower sides and base of the cranium

Front 249

temporomandibular joint 593

Back 249

connection on either side of the head between the temporal bone of the skull and mandibular bone of the jaw r

Front 250

thoracic vertebrae 586

Back 250

the second set of 12 vertebrae

Front 251

tibia 598

Back 251

shin bone

Front 252

tibial 598

Back 252

pertaining to the tibia

Front 253

ulna 589

Back 253

the forearm

Front 254

ulnar 598

Back 254

pertaining to the ulna

Front 255

vertebroplasty 596

Back 255

surgical repair of the vertebrae

Front 256

vomer 584

Back 256

the thin, single, flat bone that forms the lower portion of the nasal septum

Front 257

zygomatic bones 584

Back 257

two bones, one on each side of the face, that form the high portion of the cheek

Front 258

achondroplasia 604

Back 258

no development of cartilage

Front 259

amyotrophic lateral sclerosis 615

Back 259

condition where muscles are affected by degeneration of nerves in the spinal cord and lower region of the brain

Front 260

ankylosis 606

Back 260

chronic, progressive arthritis with stiffening of joints, primarily of the spine

Front 261

arthrodesis 605

Back 261

to bind the joints

Front 262

arthrotomy 604

Back 262

process of cutting the joint

Front 263

articular cartilage 603

Back 263

smooth, glistening white tissue that covers the surface of a joint

Front 264

atrophy 615

Back 264

no development

Front 265

bursitis 604

Back 265

inflammation of bursa

Front 266

chondroma 604

Back 266

mass of cartilage

Front 267

chondromalacia 604

Back 267

softening of the cartilage

Front 268

fasciectomy 614

Back 268

removal of the fascia

Front 269

fibromyalgia 614

Back 269

pain of the fibrous muscle connective tissue

Front 270

hemathrosis 604

Back 270

condition of blood in the joints

Front 271

hydrathrosis 604

Back 271

condition of fluid in the joints

Front 272

hypertrophy 615

Back 272

excessive delevopment

Front 273

hyperuricemia 606

Back 273

accumulation of blood in the joints

Front 274

leiomyoma 615

Back 274

tumor of the smooth muscle

Front 275

leimyosarcoma 615

Back 275

malignant tumor of the smooth muscle of the sacral

Front 276

ligamentous 605

Back 276

pertaining to ligament

Front 277

myalgia 615

Back 277

muscle pain

Front 278

myopathy 615

Back 278

disease of the muscle

Front 279

myositis 615

Back 279

inflammation of the muscle

Front 280

podagra 606

Back 280

pain in the foot

Front 281

polyarthritis 604

Back 281

inflammation of many joints

Front 282

polymyalgia 615

Back 282

pain of many muscles

Front 283

pyrexia 606

Back 283

fever

Front 284

rhabdomyosarcoma 615

Back 284

tumor of the skeletal muscle of the sacral

Front 285

rheumatologist 605

Back 285

one who specializes in the study watery flow

Front 286

sarcopenia 615

Back 286

deficiency of muscle and flesh

Front 287

sprain 609

Back 287

trauma to a joint without rupture

Front 288

subluxation 608

Back 288

partial or incomplete dislocation

Front 289

synovitis 605

Back 289

inflammation of synovial membrane

Front 290

tendinitis 605

Back 290

inflammation of tendon

Front 291

tenorrhaphy 605

Back 291

tendon suture

Front 292

tenosynovitis 605

Back 292

inflammation of the tendon sheath

Front 293

bone density test 618

Back 293

low-energy x-ray absorption in bones of the spinal column, pelvis , and wrist is used to measure bone mass

Front 294

computed tomography 619

Back 294

x-ray beam and computer provide cross-sectional and other images

Front 295

diskography 619

Back 295

x-ray examination of cervical or lumbar intervertebral disk after injection of contrast into nucleus pulposus

Front 296

magnetic resonance imagining 619

Back 296

a magnetic field creates images of soft tissue