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By F. Falk. Bryan College. 2019.

To ical and biological properties of the compounds discussed in ensure patients’ welfare order cymbalta 40 mg on line, there is still an obvious need to this section are summarized in Table 1 buy cymbalta 40 mg mastercard. Herbal Therapy for T2D for the plants that comprise the genus Glycyrrhiza buy 40mg cymbalta overnight delivery,isutilized as herbal medicine for a wide range of diseases. Te ethanol Long before the birth of orthodox Western medicine, medic- extract of G. Further, amorfrutins complicated reasons, Western medicine now prevails over isolated from the licorice, G. Cinnamon has traditionally been used for rheumatism, wounds, diarrhea, headaches, and colds 4. Recently, extensive studies have been performed on of Dioscorea is used as a traditional Chinese medicine for the action of cinnamon on diabetes and metabolic syndrome asthma, abscesses, chronic diarrhea, and ulcers [41]. Cinnamon was shown to reduce blood glucose via studies on rodent models of diabetes have reported that reduction of insulin resistance and increase of hepatic glyco- Dioscorea extract improves glycemic control and insulin genesis [135, 137]. Further, Dioscorea extract reduced blood the active compounds in modulation of insulin signaling [53, glucose in high fat diet-induced rats [41]. Tis compound from cinnamon extract is thought of pS6K and increase of the phosphorylation of Akt and glucose as a potential antidiabetic agent [139]. Another study demonstrated molecular target of cinnamon and cinnamaldehyde remains that Dioscorea polysaccharides reduced insulin resistance unclear. Te seeds of fenugreek (Trigonella foenum- graecum)areusedasafoodsupplementandalsohavea long history of medicinal use for labor induction, helping 4. Fenugreek is considered a diabetes, diabetic complications, and digestion [45, 129–132]. Notably, blueberries contain powerful antioxidants that can Te glucose-lowering action of this plant involves reduction neutralize free radicals that cause neurodegenerative disease, of insulin resistance [142]. Accordingly, pheno- trigoneosides, and 4-hydroxyisoleucine have been identifed licsandanthocyaninswereproposedasactivecompoundsfor as the active antidiabetic compounds in fenugreek. Te data confrm the benefcial efect that fenugreek exerts hypoglycemic control via increasing of blueberry on metabolic syndrome. Its seeds are used as a Chinese herbal medicine for pain, Astragalus membranaceus has long been used as a Chinese gastrointestinal diseases, and others. Recently, lychee seed medicine and shows antioxidant, antidiabetic, antihyperten- wasreportedtohaveantidiabeticactivityinrats[56]and sive, and immunomodulatory activities [133]. Moreover, treatment with Astragalus oligonol from lychee fruit showed anti-oxidative activity and, polysaccharides resulted in better glycemic control in dia- thus, protected the liver and kidney in T2D animal models beticrodentsviaanincreaseininsulinsensitivity[48–50]. Te mode of action of Astragalus polysaccharides includes Akt activation and upregulation of Glut4 and inhibition of 4. In this section, plant chemicals and/or extracts are listed according to their impact on cells. More tion ((re)generation and survival) in cells, animals, and T2D recently, the extract of G. Vanillin and 4-hydroxybenzaldehyde of the compounds discussed in this section are summarized wereproposedastheactivecompounds. Cono- pilosa, 2-ß-d-glucopyranosyloxy-1-hydroxytrideca-5,7,9,11- phylline, a plant alkaloid present in T. Tese data imply a plausible role for function through a signaling cascade of calcium infux, conophylline and T. However, the clinical nation therapy that targets multiple pathways involved in potential of this compound in -cell survival and regenera- metabolism could be a better remedy for T2D. Nymphayol, a plant sterol, was initially herb that has been used to treat diabetes for centuries. Aside from antioxidant, anti-infammatory, and hep- discussed in this section are summarized in Table 1. It has been reported that established a link between high intake of soluble dietary silymarin can rescue -cell function in alloxan-treated rats fber and improved hyperglycemia and insulin secretion in [68]. Inulins (Rafilose) are soluble dietary fbers made of short-chain fructans present in the roots of 4. Ubillas and colleagues studyshowedthatinulin-typefructanscouldpreventobe- showed that the aqueous ethanol extract of the aerial part of sity,steatosis,andhyperglycemia. Based demonstrated to stimulate incretin secretion in the colon of on a bioactivity-guided identifcation, 2 polyynes, 3-ß-d- rats through their fermentation [80, 81]. A sedentary lifestyle with a diet overly high in fat 22 Evidence-Based Complementary and Alternative Medicine usually accompanies obesity and T2D [148, 149]. Of note, berberine had a mild antidyslipidemic efect fat was found to stimulate incretin secretion [150]. Bitter melon, the fruit of the plant by ingesting fat before a carbohydrate meal in T2D patients Momordica charantia is used in Ayurvedic medicine [156]. In addition, T2D patients took control meals and control Te biochemistry and bioactivities associated with the antidi- meals supplemented with olive oil (74% monounsaturated abetic efect of the extracts of bitter melon and M. However, no signifcant diferences in the level of blood that the juice of the bitter melon increased cells in the glucose, insulin, or fatty acids were observed [85]. Herbs and Compounds Tat Regulate Glucose Absorp- anditsfruit,acttolowerbloodglucoselikelybecausethey tion in the Gut. Te chemical and biological properties of possess insulin-like chemical structures [38]. Chili peppers, the fruits of the Capsicum plants, are commonly used as food and 4. Chili pepper extract exerts an insulinotropic thamus tinctorius) seeds are used as a herbal medicine for action, implying its action on cells [157]. Te data suggest that the chili pepper safower exhibited antidiabetic properties through enhanc- and its active ingredients prevent T2D via regulation of ing insulin secretion in alloxan-induced diabetic rats [151]. However, there is a Two serotonin derivatives isolated from safower seed were discrepancy over the use of capsaicin to treat T2D. Capsaicin shown to suppress -glucosidase activity to a greater degree might cause T2D via impairment of insulin secretion [96]. Butyl-isobutyl-phthalate, an active compound of as a panacea in oriental medicine. Te chemical and biological properties However, another study reported that neither ginseng had an of the compounds discussed in this section are summarized antidiabetic efect on diabetic patients [167]. Berberine, an isoquinoline alkaloid, was ginsengs may involve a reduction in insulin resistance and frst isolated from Berberis vulgaris. Ginsenosides are the primary multiple functions ranging from infammation inhibition constituents present in ginseng roots that are claimed to and cancer suppression to reduction of metabolic syndrome beneft health. With respect to T2D, protect against apoptosis of the pancreatic -cell line, Min- this compound lowered hyperglycemia, increased insulin 6cells[171]. One study proposed that ginseng alters mito- resistance, stimulated pancreatic -cell regeneration, and chondrial function as well as apoptosis cascades to ensure cell decreased lipid peroxidation in a mouse model of T2D viability in pancreatic islet cells [174]. Tus, it may be useful for treatment of T2D and from ginseng extracts were reportedly responsible for this other types of diabetes.

In studies of diabetics discount cymbalta 20 mg with amex, benfotiamine decreased advanced glycosylated end-product formation buy cymbalta 60mg with mastercard, decreased sorbitol accumulation cymbalta 60 mg on line, and reduced oxidative cellular damage. In a small study of patients with type 1, treatment with 600 mg benfotiamine with 300 mg alpha-lipoic acid produced better results in reducing the effects of hyperglycemia than benfotiamine alone. It may take a few days for the cream to start working, and it will continue to work only with regular application. The scientific investigation of acupuncture in diabetes includes both experimental and clinical studies. For example, animal experiments have shown that acupuncture can act on the pancreas to enhance insulin synthesis, increase the number of receptors on target cells, and accelerate the utilization of glucose, resulting in lowering of blood glucose. In one clinical study, 77% of patients treated with acupuncture noted significant improvement in their symptoms, with 21% noting that their symptoms were completely eliminated. Nephropathy Particularly important for kidney protection in diabetics is dietary fiber. Dietary fiber (especially soluble fiber) is fermented in the colon to produce short-chain fatty acids. These by-products are the primary fuel for the cells of the colon, and if present in high amounts, they greatly increase the colon’s waste removal capabilities. It has been shown that in the presence of a high-fermentable- fiber diet, the colon turns into a “second kidney,” collecting nitrogenous wastes from the blood and disposing of them in the feces. If a diabetic has developed serious kidney failure, then following a low-protein, low-potassium diet is necessary; unfortunately, that does not aid good glucose control, which can then promote worse kidney functioning. The main goal is to prevent end-stage renal disease from developing in the first place. Poor Wound Healing A deficiency of virtually any essential nutrient can lead to impaired wound healing. Key nutrients include vitamin C and zinc, both of which are often deficient in the diabetic. Taking a high-potency multiple vitamin and mineral formula should improve nutritional status and promote proper wound healing. Aloe vera contains a number of compounds necessary for wound healing, including vitamin C, vitamin E, and zinc, and has been shown to stimulate many factors important to wound repair. Another option is a proprietary product called Amerigel, a topical ointment featuring an oak extract (Quercus rubra) that contains quercitannic acid, catechin, ellagitannin, and proanthocyanidin, readily absorbed into damaged skin. Foot Ulcers Lack of blood supply, poor wound healing, and peripheral neuropathy are key factors in the development of diabetic foot ulcers. Key strategies in prevention and treatment are proper foot care (including care of nails and calluses), preferably by a podiatrist; regular examination of the feet by a physician; avoidance of injury; avoidance of tobacco in any form; and methods to improve local circulation. Proper foot care includes keeping the feet clean, dry, and warm and wearing well-fitting shoes. Tobacco use in any form constricts the peripheral blood vessels and can lead to more serious peripheral vascular disease with severe arterial blockages. Circulation can be improved by exercising regularly, avoiding sitting cross-legged or in other positions that compromise circulation, and massaging the feet lightly upward. Ginkgo biloba or grape seed extract can also be used to support optimal circulation. Type 2 is usually the end result of many years of chronic metabolic insult, and although it is treatable with the natural approach presented here, resolving it will take persistence. The first step in the therapy of either type 1 or type 2 is a thorough diagnostic workup. Diet, environment, and lifestyle need to be carefully studied to rule out any exposure to agents that may be inducing glucose intolerance. Then a diet, exercise, and supplement program that meets your personal needs must be developed. For maximum efficacy, ideal body weight must be achieved (see the chapter “Obesity and Weight Management”). It is important to recognize that as the natural therapies described in this chapter take effect, drug dosages must be altered, and so a good working relationship with the prescribing doctor is required. The ultimate goal is to reestablish normal blood sugar control and prevent the development of (or ameliorate) the complications of diabetes. Diet The optimal diet detailed in the chapter “A Health-Promoting Diet” is clearly the diet of choice. A low-glycemic diet rich in high-fiber foods should be stressed, and sources of healthful fats should be ingested. Nutritional Supplements for Type 1 Diabetes The recommended supplementation program depends on the existing degree of blood glucose control, as indicated by self-monitored blood glucose and A1C levels. The green tea extract should have a polyphenol content of >90% and be decaffeinated. If you are already at Level 2, the next step is to add a prescription medication (either an oral hypoglycemic drug or insulin). However, it may also be the first suggestion of a serious underlying disease or infection. Severe bloody diarrhea, diarrhea in a child less than six years of age, or diarrhea that lasts more than three days should not be taken lightly; its cause must be determined and it must be treated appropriately. Osmotic diarrhea is caused by an excess of water-soluble molecules in the stool, which results in increased fluid retention. Secretory diarrhea results from excessive secretion of ions into the bowel, with the same result of excessive water retention in the stools. Exudative diarrhea is usually due to infections and inflammatory bowel diseases, resulting in abnormal intestinal permeability and intestinal loss of serum proteins, blood, mucus, and pus. Frequent small, painful evacuations are usually a result of disease in the rectum or at the end of the colon. Inadequate-contact diarrhea is the result of inadequate contact between the intestinal contents and the absorbing surfaces, resulting in inadequate absorption. Viruses are the most common cause of infectious diarrhea, accounting for at least 75% of cases. Viruses are suspected when vomiting is prominent, the incubation period is longer than 14 hours, and the entire illness is over in less than 72 hours. A virus is likely to be the cause if there are no warning signs of bacterial infection (such as high fever, bloody diarrhea, severe abdominal pain, or more than six stools in 24 hours) and there are no epidemiological clues from the history (i. One of the most common causes of viral gastroenteritis, especially in children, is rotavirus. It can be an extremely serious infection, especially in developing countries, where it is estimated to cause more than 800,000 annual deaths among young children. Besides infectious diarrhea, common causes of chronic diarrhea include lactose intolerance, food allergies, celiac disease (gluten sensitivity), and inflammatory bowel disease (Crohn’s disease and ulcerative colitis). Lactose intolerance is due to a deficiency in the enzyme lactase, responsible for digesting the lactose found in dairy products; it is common worldwide. It has been estimated that 70 to 90% of adults of Asian, black, American Indian, and Mediterranean ancestry lack this enzyme. The frequency of deficiency is 10 to 15% among adults of northern and western European descent.

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See yourself going through your daily tasks one by one discount cymbalta 20 mg mastercard, calmly buy cheap cymbalta 40 mg line, com- posed generic cymbalta 40 mg with mastercard, unhurried, in spite of the pressures of a busy day. See yourself maintaining the same constant, stable course, in spite of the various "hurry-bells" and "pressure-bells" in your environment. See yourself in various situations which have in the past upset you—only now you remain "set," settled, poised—by not responding. Your Spiritual Thermostat Your physical body has a built-in thermostat, itself a servo-mechanism, which maintains your inner physical temperature at a steady 98. It is able to function properly in the environment because it does not take on itself the climate of the environment. You also have a built-in spiritual thermostat which en- ables you to maintain an emotional climate and atmo- sphere in spite of the emotional weather around you. Yet, your spiritual thermostat is just as necessary for emotional health and well-being as your physical thermostat is for physical health. When playing by himself, or with friends, or in small tournaments where the stakes are low, his play is flawless. People Who Come into Their Own in a Crisis For example, John Thomas, the record-breaking high- jumper from Boston University, often performs better in competition than in practice. The manager frequently turns down the man with the highest batting average, for a player who is known to "come through in the clutch. Many women are charming and gracious when talking with one person or a small informal group, but become tongue-tied, awkward, and dull at a formal dinner, or a big social occasion. On the other hand, I know a little lady who comes into her own only under the stimulus of a big occasion. Even her facial features seem to undergo a change and you find yourself thinking of her as a beautiful woman. There are students who do extremely well in day-to-day class work, but find their minds a blank when taking an examination. There are other students who are ordinary in class work, but do extremely well on important ex- aminations. If you react improperly, a crisis can rob you of the skill, control, and ability that you ordi- narily have to call upon. The so-called "money player" in sports, in business, or in social activities—the person who comes through in the clutch—who performs better under the stimulus of chal- lenge, is invariably the person who has learned either consciously or unconsciously to react well to crisis situa- tions. In order to perform well in a crisis we need to (1) learn certain skills under conditions where we will not be over- motivated; we need to practice without pressure. The crude inept stroke that he used to rescue himself becomes "fixed" and it is difficult for Mm to learn better ways of swimming. Because of his ineptness he may perish in a real crisis where he is re- quired to swim a long distance. Tolman, psychologist and expert on animal behavior at the University of California, says that both animals and men form "brain maps" or "cognitive maps" of the environment while they are learning. In the future, if this one way happens to be blocked, the animal becomes frustrated, and fails to discern alternative routes or detours. He de- velops a "one response," cut and dried, preconceived, and tends to lose the ability to react spontaneously to a new situation. Tolman found that if rats were permitted to learn and practice under non-crisis conditions, they later per- formed well in a crisis. For example, if rats were per- mitted to roam about at will and explore a maze when well fed and with plenty to drink, they did not appear to learn anything. Later, however, if the same rats were placed in the maze while hungry, they showed they had learned a great deal, by quickly and efficiently going to the goal. Other rats which were forced to learn the maze under the crisis of hunger and thirst, did not do so well. If this route were blocked the rats became frustrated and had great difficulty learning a new one. Bruner of Har- vard University trained two groups of rats to solve a maze to get food. A second group, which had eaten nothing for 36 hours, required more than 20 tries. Persons who have to learn how to get out of a burning building will normally require two or three times as long to learn the proper escape route, as they would if no fire were present. The automatic reaction mecha- nism is jammed by too much conscious effort—trying too hard. Something akin to "purpose tremor" develops and the ability to think clearly is lost. The ones who do man- age somehow to get out of the building, have learned a narrow fixated response. Put them in a different building, or change the circumstances slightly—and they react as badly the second time around as the first. But, you can take these same people, let them practice a "dry run" fire drill when there is no fire. Because there is no menace there is no excessive negative feedback to in- terfere with clear thinking or correct doing. After they have practiced this a number of times, they can be counted upon to act the same way when an actual fire breaks out. Moreover, they will have learned something about how to get out of any building, or cope with any changed circumstances. They are not committed to a rigid response, but will be able to improvise—to re- act spontaneously to whatever conditions may be present. The moral is obvious for either mice or men: Practice without pressure and you will learn more efficiently and be able to perform better in a crisis situation. When asked how he developed the perfect control and timing for his left jab which he used to cut John L. Sullivan, the Boston Strong-boy, to ribbons, Cor- bett replied that he had practiced throwing his left at his own image in the mirror more than 10,000 times in preparation for the bout. Years before he actu- ally fought Jack Dempsey in the ring, he had fought an imaginary Dempsey more than a hundred times in the privacy of his own room. When the imaginary Dempsey would make a certain move, he would practice his counter-move. Sir Harry Lauder, the famous Scottish actor and comedian, once admitted that he had practiced a certain routine 10,000 times in private before ever giving the per- formance publicly. Billy Graham preached sermons to cypress stumps in a Florida swamp before developing his compelling plat- form personality with live audiences. The most common form of shadow-boxing for public speakers is to deliver their speech to their own image in the mirror. One man I know lines up six or eight empty chairs, imagines people sitting in them, and practices his speech on the imaginary audience. When Hogan was on the links, he would go through the correct motions in his imagination before making a shot, then depend upon "muscle memory" to execute the shot correctly. They, or their coaches, refuse to permit the press to witness practice sessions, and even refuse to give out any information concerning their practice for public- ity purposes, in order to protect themselves from pres- sure.

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These tests include endomysial antibodies purchase cymbalta 20mg mastercard, anti-tissue transglutaminase antibodies cheap cymbalta 40 mg free shipping, and anti-gliadin antibodies order 20 mg cymbalta otc. In patients with celiac disease, anti-gliadin antibody is an antibody produced against gliadin in the diet, and endomysial and anti-tissue transglutaminase antibodies are antibodies produced against the body’s own tissues as an unfortunate side effect of the immune system’s reaction to gliadin. The prevalence of celiac disease is much higher in these areas than in other parts of the world. In the United States, with its diverse genetic background, the frequency rate is now roughly 1 in 100. The early introduction of cow’s milk is also believed to be a major causative factor. A review article listed 55 health conditions linked to celiac disease and gluten sensitivity, including irritable bowel disease, inflammatory bowel disease, anemia, migraines, epilepsy, fatigue, canker sores, osteoporosis, rheumatoid arthritis, lupus, multiple sclerosis, and almost all other autoimmune diseases. Gluten sensitivity has also been weakly linked to lower mood scores, impairment of mental function, and autism. Even something as simple as taking a B- complex supplement produces considerable benefits. In one double-blind study, 65 celiac patients on a strict gluten-free diet for several years were randomly assigned to either a daily dose of 800 mcg folic acid, 500 mcg vitamin B12 (cyanocobalamin), and 3 mg vitamin B6 (pyridoxine) or a placebo for six months. Buckwheat and millet are often excluded as well; although buckwheat is not in the grass family and millet appears to be more closely related to rice and corn, buckwheat and millet contain compounds known as prolamins with antigenic activity similar to that of gliadin. Many gluten-free products are available in natural foods stores and online catalogs, but it’s important to read labels carefully, because some “wheat-free” products add gluten—the source of gliadin—to improve the quality of baked goods. Grains that can be used to replace gluten-containing grains include amaranth, quinoa, and various types of rice (brown, red, black, and wild). In addition, recent evidence suggests that complete elimination of gluten-related compounds (e. In a five-year study in which one group followed a gluten- and oat-free diet and another followed a gluten-free diet while consuming oats, no differences were seen with respect to duodenal villous architecture, inflammatory cell infiltration of the duodenal mucosa, or antibody titers. Detailed studies of celiac disease patients who eat oats have shown no evidence of immune activation. In one study, 39 celiac disease patients were randomly assigned to take either 50 g oats-containing gluten-free products per day or to continue without oats for one year. The lining of the intestine was not disturbed, but more signs of inflammation and allergy were evident in the oats group. It appears that oats provide an alternative in the gluten-free diet, but celiac patients should be aware of the possible increase in intestinal symptoms. In addition, other foods should be rotated, and milk and milk products should be eliminated until the patient redevelops an intestinal structure and function returns to normal. Usually with gluten elimination, clinical improvement will be obvious within a few days or weeks (30% respond within three days, another 50% within a month, and 10% within another month). In addition to treating any underlying deficiency, supplementation provides the necessary cofactors for growth and repair. Nutritional Supplements Pancreatic Enzymes The effect of pancreatic enzyme therapy in the two months following the initial diagnosis of celiac disease was investigated in one double-blind study. Results indicated that pancreatic enzyme supplementation enhanced the clinical benefit of a gluten-free diet during the first 30 days but did not provide any greater benefit than the placebo after 60 days. These results support the use of pancreatic enzyme preparations in the first 30 days after diagnosis of celiac disease. This enzyme targets both gliadin and casein (milk protein) and is resistant to breakdown by other digestive enzymes. Diet Maintenance of a strict gluten-free diet is quite difficult in the United States because of the ubiquitous presence of gliadin and other activators of celiac disease in processed foods. People with celiac disease must read labels carefully in order to avoid hidden sources of gliadin, such as some brands of soy sauce, modified food starch, ice cream, soup, beer, wine, vodka, whiskey, and malt. A pair of carotid arteries—one on each side of the neck running parallel to the jugular vein—are the main arteries that supply blood to the brain. Typically, the problem develops at the carotid bifurcation—the splitting of the carotid artery into the internal branch (supplying the brain) and the external branch (supplying the face and scalp). At the bifurcation, just as at the splitting of the stream, debris and sediment accumulate. Significant symptoms begin to appear in most cases only when the blockage of the artery has reached 90%. Symptoms of cerebral vascular insufficiency are caused by reduced blood flow and oxygen supply to the brain. The official definition of a stroke is loss of nerve function for at least 24 hours due to lack of oxygen. Some strokes are quite mild; others can leave a person paralyzed, in a coma, or unable to talk, depending on which part of the brain is affected. What makes this so insidious is that the lack of a sudden event can mask the problem, so it is not recognized until too late. In the past, evaluation of blood flow to the brain involved invasive techniques such as cerebral angiography. This procedure was similar to a cardiac (heart) angiogram (see the chapter “Angina”) and carried a relatively high side-effect rate: it caused a stroke in roughly 4% of the subjects. The modern evaluation of blood flow to the brain primarily involves the use of ultrasound techniques. These techniques determine the rate of blood flow and the degree of blockage by using sound waves. Therapeutic Considerations The considerations and recommendations in the chapter “Heart and Cardiovascular Health” are appropriate here, since the primary goal is to improve blood flow by making the arteries healthier. Diet is particularly important, as stroke patients, especially those with significant blockage of the carotid arteries, tend to have an unfavorable dietary pattern (high intake of saturated fatty acids; low intake of fruits, vegetables, and omega-3 fatty acids) that may have been a key factor leading to their stroke. The internal, common, and external carotid arteries are clamped, the lining of the internal carotid artery is opened, and the atherosclerotic plaque is removed. This surgery is risky: approximately 6 to 10% of patients will either die or suffer severe neurological damage as a result of a stroke during the surgery, and about 7 to 11% of the patients will die during or soon (less than one month) after having a carotid endarterectomy. Newer, less invasive procedures include angioplasty done by threading catheters through the femoral artery in the leg and up through the aorta to the carotid, then inflating a balloon to dilate the artery. However, it remains controversial whether angioplasty is actually safer or produces better outcomes. What is known is that carotid endarterectomies or angioplasties are of no value to patients with less than 70% blockage (as determined by an angiograph). These symptoms included short-term memory loss, vertigo, headache, ringing in the ears, lack of vigilance, and depression. These results suggest that vascular insufficiency, not a true degenerative process, may be the major cause of these so-called age-related cerebral disorders. Appropriate treatment involves following the recommendations in the chapter “Heart and Cardiovascular Health. Cervical Dysplasia • A Pap smear of the cervix showing abnormal (but not cancerous) cells The cervix is a small, cylindrical organ that comprises the lower part and neck of the uterus.

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