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Dr. Karen Toubi, Board Certified Obstetrician and Gynecologist: Comprehensive Gynecology. Karen Toubi博士,董事会认证的妇产科医生:综合妇科。
Q3 Medicine Pub Date : 2024-12-01
Sheldon Baker
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引用次数: 0
An Integrative, Non-Pharmacological Pain Management Approach In Severe Lumbar Spine Degeneration: A Case Report. 一种综合、非药物治疗严重腰椎退变疼痛的方法:1例报告。
Q3 Medicine Pub Date : 2024-12-01
Autumn Dach, Randal Anderson, Janene A Borandi
<p><strong>Introduction: </strong>Chronic low back pain (CLBP), or low back pain lasting greater than 12 weeks, is a prevalent condition that profoundly impacts the quality of life in affected individuals. Traditional treatments - such as physical therapy, medications, injections, minimally invasive procedures, and surgery - often prove ineffective in a considerable number of cases, particularly when utilized as singular modalities. Given the complex biopsychosocial nature of CLBP, a multi-modality approach tailored to each patients' unique needs is essential. This case report presents a comprehensive approach designed to address the intricate aspects of CLBP, emphasizing the advantages of individualized therapeutic strategies.</p><p><strong>Case presentation: </strong>We present a physically active 68-year-old Latin male with persistent CLBP. His medical history includes a healthy BMI, hypercholesterolemia controlled with a statin medication, and a previous meniscal repair of the left knee. Initial magnetic resonance imaging (MRI) findings revealed severe multilevel degenerative disc disease and lumbar facet arthropathy, with lower lumbar foraminal and central canal stenosis. Despite undergoing numerous prior treatments with over the counter and prescription analgesics, physical therapy, epidural steroid injections, and radiofrequency ablations, his pain disrupted his ability to perform activities of daily living, professional tasks, and recreational pursuits. Due to the multiple structural abnormalities identified on imaging and the severity of his pain, a complex neurosurgical intervention was offered. In collaboration with the patient, we formulated a personalized treatment plan that effectively addressed his individual goals such as avoidance of neurosurgery, pain relief, and improved function. The integrated interventions provided within the acupuncture practice included personalized acupuncture to promote innate healing, use of an inversion table for spinal decompression, and lifestyle modifications to support his overall biopsychosocial health. Additionally, we supported multi-disciplinary treatments such as chiropractic adjustments to improve spinal alignment, physical therapy to address biomechanics, and ozone therapy and platelet-rich plasma injections to facilitate structural repair. Formal standardized assessment tools, such as the Visual Analog Scale for pain intensity, were not used to measure treatment progress or outcomes. Instead, we prioritized evaluating his ability to perform personal and professional tasks, which were deemed more critical to the patient. After four months of treatments, the patient reported significant symptom resolution, improved function and performance at work, as well as enhanced quality of life despite potential degenerative progression identified on follow-up imaging.</p><p><strong>Discussion: </strong>Current literature regarding the management of CLBP highlights the efficacy of a methodical multi-dis
慢性腰痛(CLBP),或持续超过12周的腰痛,是一种严重影响患者生活质量的普遍疾病。传统的治疗方法,如物理治疗、药物治疗、注射、微创手术和外科手术,在相当多的病例中往往被证明是无效的,特别是当作为单一的方式使用时。鉴于CLBP复杂的生物心理社会性质,针对每位患者的独特需求量身定制的多模式方法是必不可少的。本病例报告提出了一种综合的方法,旨在解决CLBP的复杂方面,强调个性化治疗策略的优势。病例介绍:我们报告一位身体活跃的68岁拉丁男性,患有持续性CLBP。病史包括健康的身体质量指数,他汀类药物控制的高胆固醇血症,左膝半月板修复史。最初的磁共振成像(MRI)结果显示严重的多节段退变性椎间盘疾病和腰椎小关节病,伴有下腰椎椎间孔和中央椎管狭窄。尽管接受了多次非处方镇痛药、物理治疗、硬膜外类固醇注射和射频消融治疗,他的疼痛仍然影响了他日常生活、专业工作和娱乐活动的能力。由于影像学上发现的多重结构异常和疼痛的严重程度,我们提供了复杂的神经外科干预。在与患者的合作下,我们制定了一个个性化的治疗计划,有效地解决了他的个人目标,如避免神经外科手术,缓解疼痛,改善功能。在针灸实践中提供的综合干预措施包括个性化针灸以促进先天愈合,使用倒排床进行脊柱减压,以及改变生活方式以支持其整体生物心理社会健康。此外,我们支持多学科治疗,如脊椎指压调整以改善脊柱排列,物理治疗以解决生物力学问题,臭氧治疗和富血小板血浆注射以促进结构修复。正式的标准化评估工具,如疼痛强度的视觉模拟量表,未用于衡量治疗进展或结果。相反,我们优先评估他执行个人和专业任务的能力,这对病人来说更为重要。经过四个月的治疗,患者报告了明显的症状缓解,改善了功能和工作表现,以及提高了生活质量,尽管在随访成像中发现了潜在的退行性进展。讨论:目前关于CLBP管理的文献强调了系统的多学科方法的有效性,包括医学、心理、物理和介入性方法。有许多组织临床实践指南可以帮助护理团队管理CLBP。然而,缺乏标准化的方法,加上许多卫生系统支持各种治疗方案的能力有限,对提供者和患者都构成了重大挑战。本病例报告旨在解决个体化方法的优势,以帮助导航CLBP管理的复杂性,特别是当药物或手术治疗不首选。通过这种方法,我们强调个性化评估和开放对话的重要性,以制定双方同意的治疗目标和方案,以提高患者满意度和结果。我们的报告强调需要进一步的纵向研究来评估CLBP长期治疗的疗效,即使在x线检查显示脊柱退变恶化的情况下也是如此。它还恳求进一步的临床试验来研究CLBP的非药物和非手术治疗选择。此外,我们呼吁采取行动,加强临床实践指南,开发系统的工具,扩大多学科转诊,以改善护理。
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引用次数: 0
Open Letter to President Trump. How to Cure the Disease Treatment System? Make It a Health Care System. 致特朗普总统的公开信。如何治愈疾病治疗系统?让它成为一个医疗保健系统。
Q3 Medicine Pub Date : 2024-12-01
Joseph Pizzorno

Clearly the current way we address health and disease in the United States is not working. We now suffer the highest burden of chronic disease in every age group ever in human history. And, at the same time, we have the most expensive health care system ever. Why? Because the actual causes of disease are not being addressed. Eight years ago, when you were first elected president, I gathered together the leadership of natural, integrative, functional, and environmental medicine to provide guidance on what needed to change. Unfortunately, none of our recommendations were addressed, every measure of health and disease burden has worsened, and health care costs continue to increase far beyond the rate of inflation. President Trump, please take a look and consider these recommendations.

很明显,我们目前在美国处理健康和疾病的方式是行不通的。我们现在承受着人类历史上每个年龄组中最沉重的慢性病负担。与此同时,我们拥有有史以来最昂贵的医疗保健系统。为什么?因为疾病的真正原因没有得到解决。八年前,当您第一次当选总统时,我召集了自然医学、综合医学、功能医学和环境医学的领导,就需要改变的方面提供指导。不幸的是,我们的建议没有一项得到处理,健康和疾病负担的每一项指标都恶化了,医疗保健费用的增长速度继续远远超过通货膨胀率。特朗普总统,请考虑一下这些建议。
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引用次数: 0
Conversation with Joseph Pizzorno, ND, Part 2. 与约瑟夫-皮佐诺(Joseph Pizzorno)的对话,第 2 部分。
Q3 Medicine Pub Date : 2024-11-01
Sheldon Baker
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引用次数: 0
Blastocystis hominis; Friend or Foe. 人腔囊泡菌;是敌是友。
Q3 Medicine Pub Date : 2024-11-01
Gavin Guard

Blastocystis hominis (B. hominis) remains the most common parasite identified through stool examination. A clinician will undoubtedly encounter the presence of this parasite numerous times in their career. Thus, it is vital to know if this organism is a 'friend or foe', or in other words, whether it is a commensal or a pathogen. This will help clinicians decide whether to treat or not. This literature review discusses the best available evidence of the association of B. hominis and two diseases- irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). Particularly, focus has been paid to the effect of antimicrobial therapy in improving disease activity/symptoms and concluding on the pathogenicity of B. hominis based on in vitro, observational studies, and randomized controlled trials. Most importantly, the review presents a concise set of recommendations for when and how to treat B. hominis in a patient presenting gastrointestinal ailments.

人腔母细胞梭菌(B. hominis)仍然是粪便检查中最常见的寄生虫。临床医生在其职业生涯中无疑会多次遇到这种寄生虫。因此,了解这种寄生虫是 "敌是友",换句话说,是共生还是病原体至关重要。这将有助于临床医生决定是否进行治疗。本文献综述讨论了人乳头瘤病毒与两种疾病--肠易激综合征(IBS)和炎症性肠病(IBD)--相关的现有最佳证据。特别是,根据体外研究、观察性研究和随机对照试验,重点讨论了抗菌治疗在改善疾病活动/症状方面的效果,并对人乳头瘤病毒的致病性做出了结论。最重要的是,该综述就何时以及如何治疗胃肠道疾病患者的人吸虫提出了一套简明的建议。
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引用次数: 0
Lifestyle Medicine and the Microbiome: Holistic Prevention and Treatment. 生活方式医学与微生物组:整体预防和治疗。
Q3 Medicine Pub Date : 2024-11-01
Shawn Manske
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引用次数: 0
Provoked Seizure Triggered By Electrolyte Imbalance And Substance Use: A Case Report. 电解质失衡和药物使用引发的诱发性癫痫发作:病例报告。
Q3 Medicine Pub Date : 2024-11-01
Sierra Solnick

This case report explores the diagnostic challenges in evaluating first-time seizures by highlighting the importance of differentiating between provoked and unprovoked seizures. The patient, a 65-year-old female, experienced her first seizure during a yoga retreat in Costa Rica, influenced by a perfect storm of overlapping factors such as traveler's diarrhea, alcohol consumption, and THC use. Comprehensive evaluation and laboratory assessments revealed an elevated hematocrit and borderline magnesium deficiency. Despite limitations in reporting accuracy and the lack of immediate medical transfer, these findings did not hinder the diagnostic process. This episode, classified as a provoked seizure, highlights the necessity of a detailed case history when evaluating a presumed first-time seizure, targeted electrolyte assessment, and hydration strategies to inform clinical decision-making.

本病例报告通过强调区分诱因发作和非诱因发作的重要性,探讨了评估首次癫痫发作的诊断难题。患者是一名 65 岁的女性,她在哥斯达黎加进行瑜伽静修期间经历了第一次癫痫发作,当时受到旅行者腹泻、饮酒和服用四氢大麻酚等重叠因素的完美风暴的影响。综合评估和实验室评估显示,她的血细胞比容升高,并伴有镁缺乏症。尽管报告的准确性存在局限性,也没有立即转院,但这些发现并没有妨碍诊断过程。这次被归类为诱因性癫痫发作的病例突出表明,在评估假定的首次癫痫发作时,有必要提供详细的病史、有针对性的电解质评估和水合策略,以便为临床决策提供依据。
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引用次数: 0
Intestinal Permeability In Subjects With Rheumatoid Arthritis: A Critical Therapeutic Priority. 类风湿关节炎患者的肠道渗透性:治疗的当务之急
Q3 Medicine Pub Date : 2024-11-01
Thomas G Guilliams, Jill L Weintraub, Myles Spar

Rheumatoid arthritis is increasingly being recognized as the synovial manifestation of a group of systemic autoinflammatory conditions known as immune-mediated inflammatory diseases. While each of these conditions displays unique diagnostic signs and symptoms based on the tissue targeted by inflammation, most immune-mediated inflammatory diseases share common features, including their immune-signaling pathways. Owing to these similarities, great advances have emerged in the past few decades using therapies designed to block downstream inflammatory mediators (eg, cytokine-blocking biologics, Janus Kinase (JAK) inhibitors). Unfortunately, fewer advances have been made in therapies that have the potential to target the upstream antecedents and triggers of these complex inflammatory diseases, such as the immunologic chain of events triggered by intestinal hyperpermeability (ie, leaky gut) or gastrointestinal dysbiosis (ie, alterations in the gut microbiota). In the past few decades, intestinal hyperpermeability has emerged as an important antecedent for a wide range of chronic immunological and metabolic conditions, including celiac disease, obesity, cardiovascular disease, and a number of immune-mediated inflammatory diseases such as inflammatory bowel disease, psoriasis, and rheumatoid arthritis. In this narrative review, we discuss the growing awareness that biomarkers of intestinal permeability are frequently associated with non-gastrointestinal immune-mediated inflammatory diseases, particularly those associated with the gut-joint axis, such as rheumatoid arthritis. We suggest that measures of intestinal permeability, along with lifestyle and nutrient interventions that target gut-barrier function, may be important adjunctive clinical tools to help patients with rheumatoid arthritis achieve and maintain remission.

类风湿性关节炎被越来越多的人认为是一组全身性自身炎症的滑膜表现,这些炎症被称为免疫介导的炎症性疾病。虽然这些疾病中的每一种都会根据炎症所针对的组织显示出独特的诊断体征和症状,但大多数免疫介导的炎症性疾病都有共同的特征,包括它们的免疫信号通路。由于这些相似之处,在过去几十年中,利用旨在阻断下游炎症介质的疗法(如细胞因子阻断生物制剂、Janus 激酶(JAK)抑制剂)取得了巨大进展。遗憾的是,在有可能针对这些复杂炎症性疾病的上游前因和诱因(如肠道高渗透性(即肠道渗漏)或胃肠道菌群失调(即肠道微生物群改变)引发的免疫学事件链)的疗法方面取得的进展较少。在过去的几十年中,肠道高渗透性已成为多种慢性免疫和代谢疾病的重要诱因,包括乳糜泻、肥胖、心血管疾病以及一些免疫介导的炎症性疾病,如炎症性肠病、银屑病和类风湿性关节炎。在这篇叙述性综述中,我们将讨论人们日益认识到肠道通透性生物标志物经常与非胃肠道免疫介导的炎症性疾病相关,尤其是那些与肠道关节轴相关的疾病,如类风湿性关节炎。我们认为,肠道通透性的测量方法以及针对肠道屏障功能的生活方式和营养干预措施可能是帮助类风湿性关节炎患者达到并维持缓解的重要辅助临床工具。
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引用次数: 0
An Interview with Dr. William Parker on the Connection between Acetaminophen and Autism. 就对乙酰氨基酚与自闭症之间的联系采访威廉-帕克博士。
Q3 Medicine Pub Date : 2024-11-01
Sheldon Baker
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引用次数: 0
Impact of Microplastics and Nanoplastics on Human Health. 微塑料和纳米塑料对人类健康的影响。
Q3 Medicine Pub Date : 2024-09-01
Lyn Patrick, Joseph Pizzorno

Microplastics and nanoplastics are pervasive in the environment and pollute every tissue in the body. Emerging research demonstrates a positive correlation between tissue concentrations of microplastics and several common diseases. The sources of exposure are well understood and can be controlled. However, there appear to be no clinical trials for eliminating microplastics from tissues.

微塑料和纳米塑料在环境中无处不在,污染着人体的每一个组织。最新研究表明,微塑料在组织中的浓度与几种常见疾病之间存在正相关。人们已经充分了解并可以控制接触源。然而,目前似乎还没有从组织中消除微塑料的临床试验。
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引用次数: 0
期刊
Integrative medicine
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