Developing a Psychosomatic Imagination in Medical Students and Psychotherapy Trainees

How can we help medical students and psychotherapy trainees to develop an awareness of the mind in relation to the body, so that both can develop a psychosomatic imagination? This is an exploration of some of the difficulties that medical students have in appreciating the role of emotions in illness and of the difficulties psychotherapy trainees have in considering the importance of the body in psychotherapeutic work with patients with physical symptoms. Student Balint discussion groups and student psychotherapy schemes give clinical medical students the opportunity to explore their own and their patients’ emotional reactions to illness and to learn about the interplay of emotions with the body in physical illness. The Royal College of Psychiatrists is now encouraging the development of such Balint groups and/or psychotherapy schemes in all UK medical schools. Psychotherapy trainees studying the effects of emotions in psychosomatic illnesses often have difficulty in learning how to interpret physical symptoms that occur in psychotherapy. They tend to want to see such symptoms as having symbolic meaning and find it hard to appreciate the medical logic of physical illness. It is important that some medical understanding of these conditions is also included in seminars on psychosomatic conditions.     

Low‐Magnitude Mechanical Stimulation to Improve Bone Density in Persons of Advanced Age: A Randomized,Placebo‐Controlled Trial

Nonpharmacologic approaches to preserve or increase bone mineral density (BMD) include whole‐body vibration (WBV), but its efficacy in elderly persons is not clear. Therefore, we conducted the Vibration to Improve Bone in Elderly Subjects (VIBES) trial, a randomized, placebo‐controlled trial of 10 minutes of daily WBV (0.3g at 37 Hz) in seniors recruited from 16 independent living communities. The primary outcomes were volumetric BMD of the hip and spine measured by quantitative computed tomography (QCT) and biochemical markers of bone turnover. We randomized 174 men and women (89 active, 85 placebo) with T‐scores –1 to –2.5 who were not taking bone active drugs and had no diseases affecting the skeleton (mean age 82 ± 7 years, range 65 to 102). Participants received daily calcium (1000 mg) and vitamin D (800 IU). Study platforms were activated using radio frequency ID cards providing electronic adherence monitoring; placebo platforms resembled the active platforms. In total, 61% of participants in the active arm and 73% in the placebo arm completed 24 months. The primary outcomes, median percent changes (interquartile range [IQR]) in total volumetric femoral trabecular BMD (active group (2.2% [–0.8%, 5.2%]) versus placebo 0.4% [–4.8%, 5.0%]) and in mid‐vertebral trabecular BMD of L₁ and L₂ (active group (5.3% [–6.9%, 13.3%]) versus placebo (2.4% [–4.4%, 11.1%]), did not differ between groups (all p values > 0.1). Changes in biochemical markers of bone turnover (P1NP and sCTX) also were not different between groups (p = 0.19 and p = 0.97, respectively). In conclusion, this placebo‐controlled randomized trial of daily WBV in older adults did not demonstrate evidence of significant beneficial effects on volumetric BMD or bone biomarkers; however, the high variability in vBMD changes limited our power to detect small treatment effects. The beneficial effects of WBV observed in previous studies of younger women may not occur to the same extent in elderly individuals. © 2015 American Society for Bone and Mineral Research.     

Estimated Lean Mass and Fat Mass Differentially Affect Femoral Bone Density and Strength Index but Are Not FRAX Independent Risk Factors for Fracture

Although increasing body weight has been regarded as protective against osteoporosis and fractures, there is accumulating evidence that fat mass adversely affects skeletal health compared with lean mass. We examined skeletal health as a function of estimated total body lean and fat mass in 40,050 women and 3600 men age ≥50 years at the time of baseline dual‐energy X‐ray absorptiometry (DXA) testing from a clinical registry from Manitoba, Canada. Femoral neck bone mineral density (BMD), strength index (SI), cross‐sectional area (CSA), and cross‐sectional moment of inertia (CSMI) were derived from DXA. Multivariable models showed that increasing lean mass was associated with near‐linear increases in femoral BMD, CSA, and CSMI in both women and men, whereas increasing fat mass showed a small initial increase in these measurements followed by a plateau. In contrast, femoral SI was relatively unaffected by increasing lean mass but was associated with a continuous linear decline with increasing fat mass, which should predict higher fracture risk. During mean 5‐year follow‐up, incident major osteoporosis fractures and hip fractures were observed in 2505 women and 180 men (626 and 45 hip fractures, respectively). After adjustment for fracture risk assessment tool (FRAX) scores (with or without BMD), we found no evidence that lean mass, fat mass, or femoral SI affected prediction of major osteoporosis fractures or hip fractures. Findings were similar in men and women, without significant interactions with sex or obesity. In conclusion, skeletal adaptation to increasing lean mass was positively associated with BMD but had no effect on femoral SI, whereas increasing fat mass had no effect on BMD but adversely affected femoral SI. Greater fat mass was not independently associated with a greater risk of fractures over 5‐year follow‐up. FRAX robustly predicts fractures and was not affected by variations in body composition. © 2014 American Society for Bone and Mineral Research.     

Body Size and the Risk of Primary Hyperparathyroidism in Women: A Cohort Study

Greater body weight and fat mass have been associated with higher serum parathyroid hormone levels and a higher prevalence of primary hyperparathyroidism (P‐HPTH) in women. However, prospective studies to evaluate whether greater body size associates with a higher incidence of developing P‐HPTH have not been reported. We investigated whether greater body size was independently associated with a higher risk for developing P‐HPTH in women. We conducted a prospective cohort study of 85,013 female participants in the Nurses’ Health Study I followed for up to 26 years. Body size was measured via multiple metrics: weight, body mass index (BMI), and waist circumference (WC). Weight and BMI were assessed every 2 years from 1986 to 2012, and WC was assessed in 1986, 1996, and 2000. Detailed dietary and demographic exposures were quantified via validated biennial questionnaires. Incident cases of P‐HPTH were confirmed by individual medical record review. Cox proportional hazards models were used to evaluate whether WC, weight, and BMI were independent risk factors for developing P‐HPTH. Models were adjusted for demographic variables, comorbidities, medications, intakes of calcium and vitamin D, and exposure to ultraviolet light. We confirmed 491 incident cases of P‐HPTH during 2,128,068 person‐years of follow‐up. The multivariable‐adjusted relative risks for incident P‐HPTH increased across quartiles of WC: Q1, ref; Q2, 1.34 (0.97, 1.86); Q3, 1.70 (1.24, 2.31); Q4, 2.27 (1.63, 3.18); p trend < 0.001. Similarly, the multivariable‐adjusted risks for incident P‐HPTH increased across quartiles of weight: Q1, ref; Q2, 1.23 (0.92, 1.65); Q3, 1.63 (1.24, 2.14); Q4, 1.65 (1.24, 2.19); p trend < 0.001. A similar but statistically non‐significant trend was observed across quartiles of BMI (p trend = 0.07). In summary, body size may be an independent and modifiable risk factor for developing P‐HPTH in women. © 2017 American Society for Bone and Mineral Research.     

Impact of Competing Risk of Mortality on Association of Weight Loss With Risk of Central Body Fractures in Older Men: A Prospective Cohort Study

To determine the association of weight loss with risk of clinical fractures at the hip, spine, and pelvis (central body fractures [CBFs]) in older men with and without accounting for the competing risk of mortality, we used data from 4523 men (mean age 77.5 years). Weight change between baseline and follow‐up (mean 4.5 years between examinations) was categorized as moderate loss (loss ≥10%), mild loss (loss 5% to <10%), stable (<5% change) or gain (gain ≥5%). Participants were contacted every 4 months after the follow‐up examination to ascertain vital status (deaths verified by death certificates) and ask about fractures (confirmed by radiographic reports). Absolute probability of CBF by weight change category was estimated using traditional Kaplan‐Meier method and cumulative incidence function accounting for competing mortality risk. Risk of CBF by weight change category was determined using conventional Cox proportional hazards regression and subdistribution hazards models with death as a competing risk. During an average of 8 years, 337 men (7.5%) experienced CBF and 1569 (34.7%) died before experiencing this outcome. Among men with moderate weight loss, CBF probability was 6.8% at 5 years and 16.9% at 10 years using Kaplan‐Meier versus 5.7% at 5 years and 10.2% at 10 years using a competing risk approach. Men with moderate weight loss compared with those with stable weight had a 1.6‐fold higher adjusted risk of CBF (HR 1.59; 95% CI, 1.06 to 2.38) using Cox models that was substantially attenuated in models accounting for competing mortality risk and no longer significant (subdistribution HR 1.16; 95% CI, 0.77 to 1.75). Results were similar in analyses substituting hip fracture for CBF. Older men with weight loss who survive are at increased risk of CBF, including hip fracture. However, ignoring the competing mortality risk among men with weight loss substantially overestimates their long‐term fracture probability and relative fracture risk. © 2016 American Society for Bone and Mineral Research.     

The renin–aldosterone system and drospirenone

In the current study, we aimed to investigate whether serum salusin α and β levels are different in PCOS subjects. Fifty women with PCOS and 50 healthy, age- and body mass index matched controls were included to the prospective cross-sectional study. All subjects underwent venous blood drawing on the early follicular phase after an overnight fasting. Serum salusin α and β levels were measured with EIA, and ELISA respectively. The relationships between serum salusin levels and anthropometric and metabolic parameters were also assessed. Plasma salusin α and β levels were higher in women with PCOS compared to control group. Serum salusin α level correlated positively with salusin β and fasting serum insulin levels. The serum salusin β levels were correlated positively with HOMA-IR, TG, LDL-C, LH, FSH, and total testosterone levels. Our results indicate that salusins, newly identified regulators of hemodynamics and mitogenesis, are increased within the serum of women with PCOS.     

Bone Mass and Metabolism in Dermatitis Herpetiformis

Dermatitis herpetiformis is a gluten-sensitiveskin disease with intestinal lesions and malabsorptionsymptoms less severe than those found in celiac disease.While several studies have shown the occurrence of osteopenia in celiac disease, bone mass andmetabolism have never before been evaluated indermatitis herpetiformis. Therefore, in 16 untreatedpatients, 16 sex- and age-matched untreated celiacpatients, and 16 sex- and age-matched healthy volunteers,lumbar and femoral bone mineral density were measuredand bone and mineral metabolism and nutritional statuswere evaluated. All these parameters were significantly altered in the two groups of patients andalthough the degree of these alterations was milder inpatients with dermatitis herpetiformis than in celiacpatients, the presence of subtotal villous atrophy in patients with dermatitis herpetiformis wasassociated with the presence of more severe alterations.Bone mineral density was significantly correlated withnutritional status, and patients showing bone loss were characterized by a body mass indexlower than 20. Alterations of bone mass and mineralmetabolism complicate dermatitis herpetiformis whensevere intestinal lesions coexist. A low nutritional status may be predictive of the presence ofbone loss.     

针刺对急性肺系感染临床退热初探

针刺合谷、肺俞、大椎、膻中等穴，对１４２例急性肺系感染之发热患者的临床退热观察。结果表明，针刺后２０分钟内体温下降至正常或＞１．５℃者８４例，下降＞０．５～１．４℃者４６例；针刺后１０分钟内体温下降者１３０例，１０～２０分钟下降者１２例，体温下降幅度在１０分钟已达高峰；卫气证候体温下降幅度优于营血证候体温下降幅度（Ｐ＜０．０５）。证明针刺有肯定的退热效果。