Integrative Geriatric Oncology: A Review of Current Practices.

PURPOSE OF REVIEW: This article aims to offer a comprehensive review of optimal integrative medicine practices for geriatric oncology patients. Given the aging population and the global rise in cancer incidence, it is crucial to identify evidence-based modalities and employ an integrated approach to enhance cancer outcomes and quality of life in older adults. RECENT FINDINGS: It has been predicted that 20.5% (6.9 million) of new cancer cases in 2050 will occur in adults over 80 years old.1 The increasing focus on lifestyle factors in healthy aging has shed light on various overlooked areas of significance. Notably, anti-inflammatory diets and the promotion of a healthy gut microbiome have demonstrated significant impacts on overall health outcomes, bolstering the body's innate capacity to combat disease. This review delves into further evidence and extrapolation concerning integrative approaches and their influence on cancer outcomes and older adults quality of life. The complexity and unique nature of cancer in older adults requires a wide range of support from medical providers. Incorporating various integrative techniques as part of cancer treatment and side effect support can improve health outcomes and patient's quality of life. Familiarity with the lifestyle interventions and other topics explored in this review equips healthcare providers to offer tailored and holistic care to geriatric patients navigating cancer.

A Feasibility Study of AlzLife 40 Hz Sensory Therapy in Patients with MCI and Early AD.

Alzheimer's Disease (AD) and Mild Cognitive Impairment (MCI) are debilitating diseases that affect millions of individuals and have notoriously limited treatment options. One emerging therapy, non-invasive 40 Hz sensory therapy delivered through light and sound has previously shown promise in improving cognition in Alzheimer Disease (AD) rodent models. Small studies in humans have proven safe and tolerable, however exploration of feasibility and utility is limited. The purpose of this study is to examine the feasibility of this treatment in a human population through a smart tablet application that emits light and sound waves at 40 Hz to the user over the span of 1 h a day. Confirmation of entrainment of 40 Hz stimulation in the cerebral cortex was performed via EEG. 27 preliminary subjects with subjective cognitive complaints, Mild Cognitive Impairment, or AD were enrolled in the study; 11 participants completed 6 months of therapy. Of those that discontinued treatment, other health issues and difficulties with compliance were the most common causes. Participants were followed with Montreal Cognitive Assessment (MOCA) and Boston Cognitive Assessment (BOCA). For participants with subjective cognitive complaints, 2 of the 4 had improved MOCA score and 1 of 4 had improved BOCA score. For the participant with MCI, his MOCA score improved. For AD participants, 2 out of 6 had improved MOCA score and 3 of the 6 stayed stable, while 3 of 6 BOCA score improved. 4 of 11 participants specifically increased their MOCA scores in the Memory Index section. Of the 8 participants/caregivers able to speak to perceived usefulness of the study, 6 spoke to at least some level of benefit. Of these 6, 2 enrolled with subjective cognitive complaint, 1 had MCI, and 3 had AD. The therapy did not have reported side effects. However, those who did not finish the study experienced issues obtaining and operating a smart tablet independently as well as complying with the therapy. Overall, further exploration of this treatment modalities efficacy is warranted.

Complete Remission of BCG-Refractory High-grade Bladder CIS with Pharmacologic Ascorbate and Mistletoe.

Context: Bladder cancer is the fourth-most-common cancer in males in the U.S., who develop about 90% of the high-grade, carcinoma in situ (CIS) of non-muscle involved disease (NMIBC). Smoking and occupational carcinogens are well-known causes. For females without known risk factors, bladder cancer can be regarded as a sentinel environmental cancer. It's also one of the costliest to treat due to its high rate of recurrence. No treatment innovations have occurred in nearly two decades; intravesical instillation of Bacillus Calmette-Guerin (BCG), an agent in short supply globally, or Mitomycin-C (MIT-C) is effective in about 60% of cases. Cases refractory to BCG and MIT-C often undergo cystectomy, a procedure with numerous impacts on life styles and potential complications. The recent completion of a small Phase I trial of mistletoe in cancer patients that have exhausted known treatments at Johns Hopkins provides corroboration of its safety, with 25 % showing no disease progression. Objective: The study examined the benefits of pharmacologic ascorbate (PA) and mistletoe for a nonsmoking female patient with an environmental history of NMIBC refractory to BCG, in a non-smoking female with exposures in childhood and early adult life to several known carcinogens, including ultrafine particulate air pollution, benzene, toluene, and other organic solvents, aromatic amines and engine exhausts, and possibly arsenic in water. Design: The research team performed an integrative oncology case study on pharmacologic ascorbate (PA) and mistletoe, both agents shown to activate NK cells, enhance growth and maturation of T-cells, and induce dose-dependent pro-apoptotic cell death, suggesting shared and potentially synergistic mechanisms. Setting: The study began at the University of Ottawa Medical Center in Canada with treatment continuing over six years at St. Johns Hospital Center in Jackson, Wyoming, and George Washington University Medical Center for Integrative Medicine, with surgical, cytological, and pathological evaluations at University of California San Francisco Medical Center. Participant: The patient in the case study was a 76-year-old, well-nourished, athletic, nonsmoking female with high-grade CIS of the bladder. Her cancer was considered to be a sentinel environmental cancer. Intervention: Intravenous pharmacologic ascorbate (PA) and subcutaneous mistletoe (three times weekly) and intravenous and intravesical mistletoe (once weekly) were employed for an 8-week induction treatment, using a dose-escalation protocol as detailed below. Maintenance therapy was carried out with the same protocol for three weeks every three months for two years. Results: The patient has experienced a cancer-free outcome following 78 months of treatments that incorporated intravesical, intravenous, and subcutaneous mistletoe; intravenous PA; a program of selected nutraceuticals; exercise; and other supplementary treatments. Conclusions: This study is the first reported instance of combined treatments to achieve complete remission for high-grade NMIBC refractory to BCG and MIT-C, using intravesical, subcutaneous, and intravenous mistletoe and intravenous PA. It includes pharmacological information on possible mechanisms. In light of the global shortage of BCG, the high proportion of cases refractory to BCG and MIT-C, the unproven use of costly off-label pharmaceuticals, such as gemcitabine, and the relative cost-effectiveness of mistletoe and PA, clinicians should give serious consideration to employing these combined functional medicine treatments for BCG- and MIT-C-refractory NMIBC. Further research is needed with additional patients that can advance our understanding, including standardization of methods for systematically evaluating combined therapies-blinded and non-blinded, nomenclature regarding mistletoe preparation, doses, concentrations, regimes of administration, lengths of treatment, targeted cancer types, and other aspects.

Abdominal Cryptorchidism with Complete Dissociation between the Testis and Deferent Duct Mimicking Testicular Regression Syndrome.

Complete separation of the deferent duct from the epididymis in cryptorchid testes residing in the abdomen is an extremely rare variant of developmental disorders of the testis and epididymis. Available sources mention only three clinical cases similar to our observations. The unique anatomic aspects of this disorder hamper the correct diagnosis of an intra-abdominal cryptorchid testis. Two boys with nonpalpable left-sided cryptorchidism underwent diagnostic laparoscopy, revealing an intra-abdominally located testis. The epididymis was completely separated from the deferent duct, and the epididymis and testis were supplied by testicular vessels. Exploration of the inguinal canal revealed blind-ending deferent ducts. The testis was brought down through the inguinal canal and fixed in the scrotum in both boys. The follow-up examination at 6 months revealed no signs of testicular atrophy or malposition of the testis in either patient. With our observations in mind, the exclusive use of a transscrotal or transinguinal approach as the initial surgical exploration in the treatment of patients with nonpalpable forms of cryptorchidism may be inappropriate. Careful laparoscopic examination of the abdominal cavity is indispensable in children with suspected testicular regression syndrome or nonpalpable forms of cryptorchidism.

Current Approaches to Yoga in U.S. Medical Schools: Scoping Review of the Literature.

Background: Yoga is described as a system of physical and mental practices originating from India that connects mind, body, and spirit with techniques such as physical exercises, breathing, and meditation to promote health and well-being. Medical students experience an immense amount of stress that unfortunately continues throughout their residency and careers. Yoga represents a tool to reduce stress and support medical student resilience. Objective: This study aims to evaluate the current approaches to yoga in U.S. medical schools. Methods: A scoping literature review was conducted using search terms such as "medical school," "medical student," "medical education," "yoga," "asana," "pranayama," and "mindfulness." The primary aim of the review was to examine if U.S. medical schools offer accessible yoga to medical students and the characteristics of those yoga programs. Results: The search yielded 1313 primary articles. All titles and abstracts were screened for eligibility. Duplicate articles were removed, and 156 articles were reviewed independently by two authors. A total of eight articles met all the criteria. Yoga is offered in medical schools through three main models: recreational, research, and educational. All of the studies indicated various positive effects on medical students from these yoga programs, including in psychological states, perceived stress, and scores on medical knowledge assessments. Conclusions: Yoga aligns well with the objectives of medical education by combining physician resiliency, mindfulness, and education that can ultimately serve patients. Greater opportunities should be created to engage medical students in yoga through the length of their entire undergraduate and graduate medical training.

Antibiotic therapy of chronic bacterial prostatitis is more effective considering antibiotic susceptibility of all pathogens isolated.

PURPOSE: Because of the insufficient efficacy of the current treatment of chronic bacterial prostatitis (CBP), it is justified to search for a more effective antibiotic therapy (ABT). MATERIALS AND METHODS: This single-centre prospective observational comparative study was conducted in 2012 to 2019 (patients: 60 men with CBP; age: 20-45 y). The clinical examination was performed on admission and at 1, 3, 6, or 12 months. All patients underwent the Meares-Stamey test to obtain expressed prostatic secretion (EPS) and/or post-massage urine (PMU) samples for extended bacteriological examination. The patients were randomly divided into 2 treatment groups (30/30 patients): group I, fluoroquinolones (FQs); group II, a combination of FQs with cephalosporins/macrolides with a treatment duration of 1 month. RESULTS: Patients of both groups had severe symptomatic CBP with an average duration of 4 years. Twenty-three microorganisms (15 aerobes, 9 anaerobes) were identified in PMU. At 3 months follow-up, a positive clinical effect was noted in both groups, which was significant (p<0.05) only in group II concerning NIH-CPSI questionnaire, leukocyturia, prostate volume, maximum urine flow, and decreased pathospermia. At 6 months follow-up, in group II the frequency of Escherichia coli and Enterococcus spp. decreased significantly. In group I aerobes changed only insignificantly from the initial level, but anaerobes increased significantly. In group II the titers of both, aerobes and anaerobes, were significantly lower (p<0.05) at 6 months follow-up as compared to initial values. CONCLUSIONS: ABT targeting all taxa in EPS/PMU is a more effective alternative to standard therapeutic regimens for CBP.

Boston cognitive assessment (BOCA) - a comprehensive self-administered smartphone- and computer-based at-home test for longitudinal tracking of cognitive performance.

Longitudinal cognitive testing is essential for developing novel preventive interventions for dementia and Alzheimer's disease; however, the few available tools have significant practice effect and depend on an external evaluator. We developed a self-administered 10-min at-home test intended for longitudinal cognitive monitoring, Boston Cognitive Assessment or BOCA. The goal of this project was to validate BOCA. BOCA uses randomly selected non-repeating tasks to minimize practice effects. BOCA evaluates eight cognitive domains: 1) Memory/Immediate Recall, 2) Combinatorial Language Comprehension/Prefrontal Synthesis, 3) Visuospatial Reasoning/Mental rotation, 4) Executive function/Clock Test, 5) Attention, 6) Mental math, 7) Orientation, and 8) Memory/Delayed Recall. BOCA was administered to patients with cognitive impairment (n = 50) and age- and education-matched controls (n = 50). Test scores were significantly different between patients and controls (p < 0.001) suggesting good discriminative ability. The Cronbach's alpha was 0.87 implying good internal consistency. BOCA demonstrated strong correlation with Montreal Cognitive Assessment (MoCA) (R = 0.90, p < 0.001). The study revealed strong (R = 0.94, p < 0.001) test-retest reliability of the total BOCA score one week after participants' initial administration. The practice effect tested by daily BOCA administration over 10 days was insignificant (ß = 0.03, p = 0.68). The effect of the screen size tested by BOCA administration on a large computer screen and re-administration of the BOCA to the same participant on a smartphone was insignificant (ß = 0.82, p = 0.17; positive ß indicates greater score on a smartphone). BOCA has the potential to reduce the cost and improve the quality of longitudinal cognitive tracking essential for testing novel interventions designed to reduce or reverse cognitive aging. BOCA is available online gratis at www.bocatest.org .

The intersection between integrative medicine and neuropathic pain: A case report.

INTRODUCTION: Neuropathic pain is a debilitating condition caused by lesion or disease of the somatosensory nervous system. Integrative modalities such as yoga, acupuncture, and massage are evidenced therapies for pain management. Additionally, medical cannabis and cannabinoids are emerging therapies for treatment of neuropathic pain (4,28). The authors of this study report a case of chronic neuropathic pain treated with integrative interventions. CASE PRESENTATION: The patient is a 71-year-old female with a past medical history of chronic neuropathic pain in her lower back and legs, degenerative arthritis, restless leg syndrome, carpal tunnel syndrome, and severe, chronic anxiety, presenting with worsening neuropathic pain. After over a decade of unsuccessful allopathic treatment, the patient sought out a more integrative approach to her pain management. A regimen of acupuncture, massage, gentle yoga, and medical cannabis was recommended. During the COVID-19 pandemic, she was unable to continue most of the integrative modalities and reported a significant increase in pain. The patient then joined a weekly Mind and Body program and began acupuncture treatments again, reporting a steady improvement in pain. CONCLUSION: The patient's chronic neuropathic pain was effectively treated using an integrative approach, with a combination of acupuncture, massage, yoga, mind-body approaches, and medical cannabis. While this case originally presented similarly to other cases of chronic neuropathic pain, it is unique in that it demonstrates the importance of an individualized complex approach, highlighting the patient's driven engagement in integrative modalities and medical cannabis.

Transposition and fixation of lower pole crossing vessel in children with ureteropelvic junction obstruction: A STROBE-compliant study.

ABSTRACT: Chapman and Hellstrom techniques are typically employed to transpose renal lower pole crossing vessels (LPCVs). Both procedures have certain limitations. We investigated the midterm outcomes in pediatric patients in whom LPCV-induced ureteropelvic junction obstruction was treated with either dismembered Anderson-Hynes pyeloplasty or upward transposition coupled with a new technique to fix the LPCV.We retrospectively compared Anderson-Hynes pyeloplasty to the new technique in terms of outcome. LPCV transposition was considered feasible in patients in whom the diuretic loading test revealed a decrease in the pelvic volume after correction of vascular compression as well as absence of structural changes in the ureteropelvic junction (UPJ) and hemodynamic compromise of the lower renal pole. The fascial flap was passed below the LPCV to form a "hammock". The free edge of the flap was sutured to its base.Group 1 consisted of 102 (69.9%) patients (median age: 7.9 years) undergoing dismembered Anderson-Hynes pyeloplasty, while group 2 included 44 (30.1%) patients (median age: 8.4 years) treated with upward transposition and the new technique to fix the LPCV. No intra-operative complications or conversions occurred in either group. Redo-pyeloplasty was performed in 3 (2.9%) children of group 1 and 1 (2.3%) child of group 2. Renal ultrasonography conducted 12 months after surgery revealed similar anteroposterior diameters of the renal pelvis in groups 1 (7.9 ±â€Š8.1 mm) and 2 (6.0 ±â€Š2.9 mm). Patients in both groups showed a non-significant median increase in differential renal function at follow-up after at least 1 year after surgery (group 1: 36% [33.3; 40.5] vs 36.5% [35.3; 41.0]; group 2: 41% [37.5; 46.0] vs 43% [39; 46]).In our patients, the new technique for laparoscopic or open fixation of the obstructing vessel after transposition was effective, reproducible, and devoid of limitations typical for the Chapman and Hellstrom techniques. We recommend Anderson-Hynes pyeloplasty in children with a history of hydronephrosis diagnosed antenatally, recurrent abdominal pain, intra-operative absence of peristalsis across the UPJ, high location of the UPJ at the renal pelvis, or intra-operative absence of volume reduction of the renal pelvis upon furosemide testing.

Does the microbiota spectrum of prostate secretion affect the clinical status of patients with chronic bacterial prostatitis?

OBJECTIVE: To explore the influence of the microbiota of prostate secretion on the clinical status of patients with chronic bacterial prostatitis. METHODS: This was an observational, single-center, comparative study. We evaluated the survey cards of 230 outpatients aged 18-45 years with a history of prostatitis from 2012 to 2019. As a result, 170 outpatients were selected for the study. All patients underwent an assessment of symptoms using International Prostate Symptom Score-quality of life, National Institutes of Health-Chronic Prostatitis Symptom Index, International Index of Erectile Function, pain visual analog scale. A bacteriological study (after the Meares-Stamey test) of post-massage urine was carried out on an extended media set. The following parameters were determined in each patient: leukocyturia and bacteriuria, serum testosterone and total prostate-specific antigen levels. Uroflowmetry, transrectal prostate ultrasound with color duplex mapping and ejaculate analysis were also carried out. RESULTS: Aerobic-anaerobic bacterial associations were identified in all patients. Three comparison groups were identified depending on the microbiota's spectrum (in post-massage urine): aerobes prevailed in group 1 (n = 67), anaerobes prevailed in group 2 (n = 33), and the levels of aerobic and anaerobic bacteriuria were higher than ≥103  colony-forming units per mL in group 3 (n = 70). It was found that the severity of clinical symptoms (urination disorders, sexual dysfunction etc.) of chronic bacterial prostatitis, laboratory and instrumental changes (testosterone, prostate-specific antigen, prostate volume etc.) in groups 2 and 3 were significantly higher than in group 1. CONCLUSION: In patients with chronic bacterial prostatitis, a predominance of anaerobes or a combination of aerobes and anaerobes in a titer of ≥103  colony-forming units per mL in post-massage urine is associated with worse clinical status.

X-ray micro-computed tomography in the assessment of penile cavernous fibrosis in a rabbit castration model.

BACKGROUND: Current assessment methods of penile cavernous fibrosis in animal models have limitations due to the inability to provide complex and volume analysis of fibrotic alterations. OBJECTIVE: The aim was to evaluate micro-computed tomography for assessment of cavernous fibrosis and compare it with histological, histochemical, immunohistochemical, and RT-PCR analysis. MATERIALS AND METHODS: A controlled trial was performed involving 25 New Zealand male rabbits with induced testosterone deficiency by orchidectomy. Penile samples were obtained before and after 7, 14, 21, and 84 days from orchidectomy. We consistently performed (a) gray value analysis of corpora cavernosa 3D models reconstructed after micro-computed tomography, (b) morphometry of smooth muscles/connective tissue ratio, collagen type I/III ratio, and area of TGF-beta-1 expression in corpora cavernosa, and (c) RT-PCR of TGF-beta-1 expression. RESULTS: Micro-computed tomography allowed visualization of penile structures at a resolution comparable to light microscopy. Gray values of corpora cavernosa decreased from 1673 (1512-1773) on the initial day to 1184 (1089-1232) on the 21st day (p < 0.005). However, on the 84th day, it increased to 1610 (1551-1768). On 21st and 84th days, there was observed a significant decrease in smooth muscle/connective tissue ratio and a significant increase in collagen type I/III ratio (p < 0.05). TGF-beta1 expression increased on the 84th day according to immunohistochemistry (p < 0.005). RT-PCR was impossible to conduct due to the absence of RNA in obtained samples after micro-CT. DISCUSSION AND CONCLUSIONS: Micro-computed tomography provided 3D visualization of entire corpora cavernosa and assessment of radiodensity alterations by gray value analysis in fibrosis progression. We speculate that gray value changes at early and late fibrosis stages could be related to tissue reorganization. RT-PCR is impossible to conduct on tissue samples studied by micro-CT due to RNA destruction. We also suggest that micro-computed tomography could negatively affect the immunohistochemical outcome, as a significant increase of TGF-beta-1 expression occurs later than histological fibrotic signs.

Medical cannabis education among healthcare trainees: A scoping review.

OBJECTIVES: It has been previously demonstrated that healthcare professionals would like additional education on medical cannabis. However, there has not yet been a review of the status of medical cannabis curriculum for medical and allied healthcare trainees worldwide, even though future healthcare workers will be placed on the forefront of patient care and must be prepared to counsel patients. This study was designed to address this gap in knowledge. DESIGN: A search syntax was generated and databases PubMed, ERIC, CINAHL, and Web of Science were searched for relevant articles. A grey literature search of Google Scholar, MedEd, Medline, and the Proquest Dissertations and Theses section was also performed. All titles and abstracts were screened. Selected articles were subsequently screened using predetermined inclusion and exclusion criteria. RESULTS: Allied healthcare trainees lacked sufficient knowledge about medical cannabis and did not feel prepared to counsel patients on this subject. Additionally, they expressed a growing interest in medical cannabis and would like more standardized education on the topic. Finally, faculty and deans in various institutions agreed on the need to educate students on the subject, and aimed to implement courses on medical cannabis or expand their existing curricula. CONCLUSIONS: While the medical cannabis landscape is developing, medical and allied health students are not properly educated and knowledgeable on this emerging field of clinical care. The findings suggest that the implementation of competencies-based curricula on medical cannabis is essential for medical and allied healthcare trainees to have the appropriate level of knowledge to counsel and educate their patients.

Religion in Russia: Its impact on university student medical cannabis attitudes and beliefs.

Despite significant research, the benefits and risks of cannabis for medical purposes remain elusive. However, there is one factor about the substance that is clear - there is a dearth of knowledge about attitudes and beliefs toward its use in Russia where the substance in any form is strictly prohibited. The aim of this study was to examine the impact of affiliation with religion on university student attitudes and beliefs toward cannabis for medical conditions. Survey data were collected from 828 medical and allied health students at two Russian universities. Findings indicate that students with a religious affiliation were significantly more likely to express negative attitudes towards medical cannabis.

One man's swordfish story: The link between Alzheimer's disease and mercury exposure.

It is well-documented that when mercury levels surpass the permissible value, individuals experience a myriad of symptoms that include chronic fatigue, dizziness, and loss of appetite. Mercury is also known to be one of the most potent neurotoxins. This case study depicts a 91- year-old who presented with cognitive decline diagnosed as Alzheimer's disease. This patient was found to have severely elevated mercury levels caused by consuming high mercury containing fish. Following diet adjustment and detoxification, this patient's cognitive impairment significantly improved in proportion to the decline in methylmercury level. One year later, his cognition and functional status rapidly and unexpectedly declined. A computed tomography (CT) scan revealed multiple new lacunar subacute strokes. Thus, it is critical to address biological etiologies such as mercury toxicity in the elderly population diagnosed with Alzheimer's, but end organ damage may not be reversible.

Ascorbate as Prophylaxis and Therapy for COVID-19-Update From Shanghai and U.S. Medical Institutions.

BACKGROUND: No validated treatments have been identified for the COVID-19 pandemic virus; several are currently in randomized clinical trials. Diagnostic instruments are rapidly evolving. Symptoms range from those of a common cold to acute respiratory distress syndrome (ARDS), to sepsis arising from the flood of inflammatory bacterial and viral pathogens in the blood. Mortality generally arises from cytokine storms of uncontrolled inflammation, oxidative injury, and damage to the alveolar-capillary barrier, with secondary bacterial infection. To address the indisputably urgent need for therapeutics for COVID-19, a specialized interdisciplinary medical panel convened in Shanghai in March 2020 to consider all relevant clinical and experimental evidence on the possible utility of intravenous (IV) ascorbate in the treatment of COVID-19-related ARDS. METHODS: The panel convened multidisciplinary medical experts and reviewed all relevant in vitro, in vivo, clinical studies and randomized controlled trials on IV ascorbate and issued a consensus report on 23 March 2020 noting that substantial differences in serum concentrations of ascorbate are achieved through IV administration in contrast with the oral route. FINDINGS: The Shanghai panel, and a parallel medical group in Guangzhou, are advising the use of high-dose IV ascorbate for the treatment of ARDS, along with other supportive therapies, including Vitamin D and zinc. We report preliminary progress in using this treatment for 50 consecutive cases treated in Shanghai hospitals, consistent with earlier reports from a meta-analysis of the use of IV ascorbate to treat sepsis. We provide an instructive clinical anecdote regarding a single family where one elderly member with cardiac and other major comorbidities developed and survived ARDS-related sepsis following daily treatments that included 15 g of IV ascorbate. None of her adult caregivers who had ingested between 2 and 10 g of ascorbate daily developed COVID-19.