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The field of psychosomatics has experienced many waves of “celebrity” since its origin. Its historical origin is impossible to precisely locate in time, one may argue that medicine since its very beginning has been psychosomatic in nature. In very recent times, many clinicians and researchers even from different backgrounds than psychosomatic medicine or psychiatry have expressed disappointment and worry about the excessive fragmentation of medical sciences, providing evidence in support and advocating towards the so-called holistic approach and integrated care. The old lesson of psychosomatic medicine, then, appears more contemporary than ever. This is also because it has been able to stay coherent but at the same time integrate the enormous progresses in the understanding of physiology and pathophysiology that medical sciences have witnessed in the last decades.The presentation will focus on the most striking scientific production of 2023 in the field of psychosomatics, to show the contributions in its three souls of research, training and clinical activities and to outline the stimulating though sometimes difficult dialogue between this area of behavioural sciences and the rest of psychiatry.Disclosure of InterestNone Declared

يكشف لنا روبين شارما عبر كتاب الخطابات السرية للراهب الذي باع سيارته الفيراري عن أفكار ثاقبة حول استعادة قوتك الشخصية، وحول كيف تصبح صادقا مع نفسك وتعيش أحلامك بلا خوف، فهي قصة خيالية تدور أحداثها حول جوناثان لاندري رجل غارق في المشاكل، بعد مقابلة غريبة مع قريبه المفقود جوليان مانتل محامي المرافعات السابق ذي النفوذ والذي اختفى فجأة في جبال الهيمالايا، اضطر جوناثان إلي السفر إلى جميع أنحاء الأرض ليجمع الخطابات المنقذة للحياة والتي تحمل الأسرار الاستثنائية التي اكتشفها جوليان، وفي تلك الرحلة التي لا تنسي والتي تضمنت زيارة قاعات التانجو في بوينس أيريس والأبراج الإمعة في شنغهاي والصحراء الغامضة في سيدونا والمقابر المخيفة في باريس. . نرى كيف يمكننا أن نغير أنفسنا، وحياتنا للأفضل.

Receptor activator of nuclear factor kappa B ligand (RANKL) and its natural antagonist, osteoprotegerin (OPG), are, respectively, an indispensable factor and a potent inhibitor for osteoclast differentiation, activity, and survival. The development of a human monoclonal antibody to RANKL, denosumab, constitutes a novel approach to prevent fragility fractures in osteoporosis, skeletal complications of malignancy, and potentially bone erosions in rheumatoid arthritis (RA). In addition to being expressed by osteoblasts, RANKL is abundantly produced by activated T cells, and synoviocytes in RA, whereas its receptor, RANK, is also expressed by monocytes/macrophages and dendritic cells. However, in preclinical and clinical studies of RA--including patients with some degree of immunosuppression--RANKL inhibitors did not significantly alter inflammatory processes. RANKL, RANK, and OPG deficiency in murine models highlights the important role of this pathway in the development and maturation of the immune system in rodents, including functions of T and/or B cells, whereas OPG overexpression in mice and rats seems innocuous with regard to immunity. In contrast, loss-of-function mutations in humans have more limited effects on immune cells. In clinical studies, the overall rate of infections, cancer, and death was similar with denosumab and placebo. Nevertheless, the risk of severe infections and cancer in some specific tissues remains to be carefully scrutinized.

حياة تمر بسرعة بالغة. ولن يفطر قلبك شيء أكثر من الوصول إلى نهايتها فتدرك أنك غفلت عن أهم ما كان فيها - لأنك كنت منشغلاً للغاية بانشغالك في الحياة.من سيبكي حين تموت؟ساعد الناس حول العالم على إعادة التركيز على حياتهم وتبسيطها لكي يحيوا بمتعة، شغف، وغاية أكبر. استمراراً للإلهام والفلسفة التي جعلت كتب الراهب تجربة تغير الحياة يشارك هذا الكتيب الذي تسهل قراءته 101 فكرة فعالة ستساعدك على خلق نجاح.

Fragility fractures are increasingly recognized as a complication of both type 1 and type 2 diabetes, with fracture risk that increases with disease duration and poor glycemic control. Yet the identification and management of fracture risk in these patients remains challenging. This review explores the clinical characteristics of bone fragility in adults with diabetes and highlights recent studies that have evaluated bone mineral density (BMD), bone microstructure and material properties, biochemical markers, and fracture prediction algorithms (i.e., FRAX) in these patients. It further reviews the impact of diabetes drugs on bone as well as the efficacy of osteoporosis treatments in this population. We finally propose an algorithm for the identification and management of diabetic patients at increased fracture risk.

هذا الكتاب \"الراهب الذى باع سيارته الفيراري\" قصة تتحدث عن جوليان مانتل المحامى اللامع الذى أدى أسلوب معيشته المفتقر للتوازن إلى إصابته بأزمة قلبية كادت أن تؤدى بحياته فى أحدى قاعات المحاكم المزدحمة بالجمهور ويقضى انهياره الجسدي إلى أزمة روحانية تجبره على مواجهة حالته والبحث عن أجوبة شافية لأهم الأسئلة الحياتية وعلى أمل منه أن يعثر على السعادة والرضا فقد انطلق فى رحلة عجيبة شبيهة بالأوديسا إلى حضارة عتيقة فماذا وجد هذا ما سنعرفه من خلال هذه القصة الرائعة.

SummaryVertebral fractures are independent risk factors for vertebral and nonvertebral fractures. Since vertebral fractures are often missed, the relatively new introduction of vertebral fracture assessment (VFA) for imaging of the lateral spine during DXA-measurement of the spine and hips may contribute to detect vertebral fractures. We advocate performing a VFA in all patients with a recent fracture visiting a fracture liaison service (FLS). Fracture liaison services (FLS) are important service models for delivering secondary fracture prevention for older adults presenting with a fragility fracture. While commonly age, clinical risk factors (including fracture site and number of prior fracture) and BMD play a crucial role in determining fracture risk and indications for treatment with antiosteoporosis medications, prevalent vertebral fractures usually remain undetected. However, vertebral fractures are important independent risk factors for future vertebral and nonvertebral fractures. A development of the DXA technology, vertebral fracture assessment (VFA), allows for assessment of the lateral spine during the regular DXA bone mineral density measurement of the lumbar spine and hips. Recent approaches to the stratification of antiosteoporosis medication type according to baseline fracture risk, and differences by age in the indication for treatment by prior fracture mean that additional information from VFA may influence initiation and type of treatment. Furthermore, knowledge of baseline vertebral fractures allows reliable definition of incident vertebral fracture events during treatment, which may modify the approach to therapy. In this manuscript, we will discuss the epidemiology and clinical significance of vertebral fractures, the different methods of detecting vertebral fractures, and the rationale for, and implications of, use of VFA routinely in FLS.Summary points• Vertebral fracture assessment is a tool available on modern DXA instruments and has proven ability to detect vertebral fractures, the majority of which occur without a fall and without the signs and symptoms of an acute fracture.• Most osteoporosis guidelines internationally suggest that treatment with antiosteoporosis medications should be considered for older individuals (e.g., 65 years +) with a recent low trauma fracture without the need for DXA.• Younger individuals postfracture may be risk-assessed on the basis of FRAX® probability including DXA and associated treatment thresholds.• Future fracture risk is markedly influenced by both site, number, severity, and recency of prior fracture; awareness of baseline vertebral fractures facilitates definition of true incident vertebral fracture events occurring during antiosteoporosis treatment.• Detection of previously clinically silent vertebral fractures, defining site of prior fracture, might alter treatment decisions in younger or older FLS patients, consistent with recent IOF-ESCEO guidance on baseline-risk-stratified therapy, and provides a reliable baseline from which to define new, potentially therapy-altering, vertebral fracture events.

هذا الكتاب \"اكتشف مصيرك مع الراهب الذي باع سيارته الفيراري\" هو دليل مبتكر لتحويل رغبات قلبك إلى حقيقة يومية وعيش الحياة التي تستحقها بصدق. والرسالة التي يحتويها هذا الكتاب ألهمت بالفعل أناسا حول العالم لكي يتحرروا من معتقداتهم المقيدة ويسموا فوق مخاوفهم ويشعروا بالسعادة الحقيقية التي طالما تاقوا إليها ولقد أضاف المؤلف البصيرة والعاطفة والرؤية التي يشتهر بها.

Romosozumab binds sclerostin, increases bone formation, and decreases bone resorption. Postmenopausal women with osteoporosis were assigned to romosozumab or placebo for 1 year, followed by 1 year of denosumab. Romosozumab was associated with lower vertebral and clinical fracture risk. Osteoporosis can lead to fragility fractures, which result in clinical burden and increased mortality. 1 , 2 Even after a fracture, fewer than 25% of patients receive pharmacologic treatment for osteoporosis. 3 – 5 After the discovery that sclerostin deficiency causes rare genetic conditions that are characterized by high bone mass and resistance to fracture, 6 , 7 sclerostin became a therapeutic target for the treatment of osteoporosis. Sclerostin, a negative regulator of bone formation that is secreted by osteocytes, 8 inhibits Wnt signaling, down-regulating this stimulus for osteoblast development and function. 9 Romosozumab (Amgen and UCB Pharma) is a monoclonal antibody that binds and inhibits sclerostin, with . . .