The Present and Future of Clinical Psychology in Private Practice

This article discusses clinical psychologists' current concerns, challenges, and opportunities in private practice. The future of clinicians in independent practice is presented within two paradigms, namely, psychology as a health profession, and psychology as life enhancement. Finally, the author argues that psychotechnology, corporate clinical psychology, and psychology as life enrichment will evolve within the future of clinical psychological independent practice.     

胚胎发育不良性神经上皮瘤的影像学与临床病理特征

目的探讨胚胎发育不良性神经上皮瘤（DNT）的MRI、CT表现及临床病理特征。方法回顾性分析经组织病理学证实的12例DNT的MRI、CT表现与临床病理特点。结果男6例，女6例，年龄12～68岁（平均36．7岁）。大多数病例以癫痫小发作为主，神经系统检查无阳性体征。MR检查病变均位于幕上结构，累及皮层，额叶（4例）及颞叶（3例）为主；最大径2-5cm不等，形态呈类圆形、分叶状或不规则状；2例累及白质，7例伴囊性变。病变在MRI均呈T1WI低信号，T2WI高信号，无病变周围水肿及占位效应；囊性病变在T1WI信号均匀，等于或略高于脑脊液。6例CT扫描病变均呈低密度改变，其中2例呈囊性分叶状，1例呈局灶性钙化；4例增强后病变无强化，1例病变内呈轻度不均匀强化。病理组织学DNT分为3型：单纯型（4例）、复杂型（6例）及非特异型（2例）。结论DNT是一种良性病变，MRI较CT更具特征性表现。     

镓合金用于牙体修复的临床应用研究

目的：观察镓合金作为一种新型的牙体修复材料在临床中的使用情况。方法：对48个牙体充填后经过6月、9月、12月、24月随访观察。结果：48个修复体中Ⅰ类洞40个、Ⅱ类洞6个、Ⅴ类洞2个，除4个修复体因充填后牙尖折断及乳牙替换而脱落，其余修复体均完整，无边缘折断或裂缝。优良率达95．5％。失败率4．5％。结论：镓合金对口腔黏膜及牙龈组织无刺激，无毒，无过敏反应，不污染环境，是一种良好的牙体修复材料。     

Comparison of parent and teacher reports of attention-deficit/hyperactivity disorder symptoms from two placebo-controlled studies of atomoxetine in children.

BACKGROUND: The validity of parent reports regarding children's attention-deficit/hyperactivity disorder (ADHD) symptoms has been questioned. This study assessed whether parent reports were as sensitive as teacher reports to document change in ADHD symptoms during clinical trials with atomoxetine. METHODS: Data were compared from two randomized, double-blind, placebo-controlled clinical trials of atomoxetine using different versions (parent or teacher) of the same rating scale (Attention-Deficit/Hyperactivity Disorder Rating Scale-IV [parent or teacher] Version: Investigator Administered and Scored - ADHD RS). Exclusion criteria included history of bipolar disorder, psychosis, seizures, alcohol abuse, or positive drug screen. Patients (6-16 years old) were treated with atomoxetine (titrated to a maximum dose of 1.8 mg/kg/day) administered once daily for up to 7 weeks. Parent and teacher ratings were compared using an analysis of covariance (ANCOVA) model. RESULTS: The analysis (n = 318) showed that treatment effects (mean change, baseline to endpoint) were similar between parent and teacher ratings (total, p = .762; inattention, p = .519; hyperactive/impulsive, p = .955). Effect sizes also were similar based on total scores (parent ratings = .69; teacher ratings = .63). CONCLUSIONS: Parent reports are as sensitive as teacher reports in assessing the efficacy of long-acting pharmacologic treatment for ADHD in children during clinical trials using the nonstimulant atomoxetine.     

33例肺上沟癌的临床特点及放疗疗效

目的　探讨肺上沟癌的临床特点及放疗疗效和不良反应。方法　回顾性分析 3 3例肺上沟癌住院病人的临床特征和常规放疗的疗效。结果　肺上沟癌占原发性支气管肺癌的 2 9% ,常见症状为 :患侧肩、背和上肢疼痛 ( 78 8% ) ,后 1,2 ,3肋骨或椎骨破坏( 5 7 6% ) ,Horner’s综合征 ( 3 6 7% ) ;少见的症状为 :咳嗽 ( 2 7% ) ,咯血 ( 9% ) ;中位生存期为 8 4月 ;1,3 ,5年生存率分别为 3 5 6% ,12 3 % ,4 6% ;放疗反应可耐受。结论　肺上沟癌相当少见 ,其临床特征基本符合pancoast综合症 ,本病预后差 ,但放疗可缓解疼痛 ,提高生存质量。     

Critical study of hair growth analysis with computer-assisted methods

BACKGROUND: Computer-assisted image analysis has been proposed for human hair growth studies. METHODS: The performances of Trichoscan, a commercially available automated system combining epiluminiscence microscopy with digital image analysis, developed for office-based hair growth measurements, have been evaluated comparatively on the same skin sites using standardized photographic equipment and calibrated processing for contrast-enhanced phototrichogram (CE-PTG) analysis. This reference method has been validated with scalp biopsies and histological examination of serial sectioning. RESULTS: Besides edge effects, hair fibres escaped the Trichoscan analysis for various reasons including, but not limited to, thickness, pigmentation, closeness and crossing. CONCLUSION: Most of these problems have been identified in the late 1980s and remain largely unsolved by the processing software that was evaluated in 2004. Therefore claims promoting the Trichoscan method for accurate hair measurements in clinical trials on scalp and body hair are not supported by the present investigation. The speed at which the analysis is performed is outweighed by the errors in signal detection. Therefore we suggest that improvements must be clearly documented before Trichoscan is established for quantified diagnostic purposes and detailed hair cycle monitoring during hair trials.     

The multiform and variable patterns of onset of orofacial granulomatosis

BACKGROUND: The recurrent chronic orofacial swelling caused by orofacial granulomatosis (OFG) can cause significant cosmetic and functional problems but can be prevented if the disease is diagnosed early and promptly treated. Although the enlargement of the lips is described to be the most common presenting complaint, the clinical onset of OFG may be characterized by minor associated mucosal and neurological manifestations, making early diagnosis very difficult or, sometimes, merely presumable. PATIENTS AND METHODS: We retrospectively analyzed the clinical manifestations of 19 patients with OFG, who were examined at our institution between 1998 and 2002, in order to determine their initial manifestations and presenting symptoms. RESULTS: A total of 10 patients showed classical recurrent enlargement of the lips (six lower; four upper) as presenting symptom. In the other nine patients, OFG onset was characterized by transient unilateral facial nerve palsy (two cases), intraoral manifestations (two cases), recurrent swelling of the periorbital area (two cases), of the chin (one case), of the zygomatic area (one case), and of the cheeks (one case). CONCLUSION: Our data underlined that OFG onset could be frequently characterized by widely variable, multiform, and temporary clinical findings. Involvement of atypical sites of the orofacial region and presence of single minor manifestations may occur as presenting symptoms, often preceding the development of traditional clinical findings.     

Preliminary laboratory based diagnostic criteria for immune thrombocytopenic purpura: evaluation by multi-center prospective study

BACKGROUND: We proposed diagnostic criteria for immune thrombocytopenic purpura (ITP) by modifying the existing guidelines for diagnosis of ITP and by incorporating laboratory tests found useful for predicting its diagnosis, for example erythrocyte count, leukocyte count, anti-GPIIb/IIIa antibody-producing B cells, platelet-associated anti-GPIIb/IIIa antibodies, percentage of reticulated platelets, and plasma thrombopoietin. OBJECTIVE AND METHODS: To validate our criteria, we conducted a multi-center prospective study involving 112 patients with thrombocytopenia and a morphologically normal peripheral blood film at the first visit. Each patient underwent a physical examination, routine laboratory tests, and specialized tests for the anti-GPIIb/IIIa antibody response and platelet turnover. RESULTS: Ninety-one patients (81%) satisfied the proposed criteria at first visit. Clinical diagnosis was made by skilled hematologists > 6 months after the first visit; ITP was diagnosed in 88 patients and non-ITP disorders in 24. The proposed criteria had 98% sensitivity, 79% specificity, a 95% positive predictive value, and a 90% negative predictive value. A relatively low specificity appears to be attributed to a few patients who had both ITP and aplastic anemia or myelodysplastic syndrome. CONCLUSIONS: Our preliminary diagnostic criteria based on ITP-associated laboratory findings were useful for the differential diagnosis of ITP, but additional evaluations and modifications will be necessary to develop criteria that can be used routinely.     

结直肠癌患者的临床、内镜、病理学特点

目的探讨结直肠癌患者临床、内镜、病理特点。方法对1991—2005年肠镜及病理证实的结直肠癌患者,按年龄分为青年组(≤30岁),中年组(31~59岁),老年组(≥60岁),从临床表现、内镜表现和病理学三方面进行回顾性分析。结果(1)本组结直肠癌患病高峰为50~65岁,男性结直肠癌构成比高于女性。(2)青年组以腹痛就诊者占70.73%,中老年组以便血就诊者占65.50%,说明临床症状具有不典型性。(3)各组直肠癌均有较高的比例,青年组右半结肠癌的发病率(34.15%)明显高于中老年组(16.33%)。(4)青年组以低分化腺癌、黏液腺癌为多,肿瘤分化程度低,恶性程度高;中老年组以高分化腺癌多见,肿瘤分化程度高,恶性程度低。结论不同年龄组结直肠癌患者有不同的临床、内镜、病理特点,对有下消化道症状的患者,应尽早、全面地进行结肠镜检查。     

进展期胃印戒细胞癌患者的临床病理特点与预后

目的研究进展期胃印戒细胞癌患者的临床病理特点及预后.方法对571例进展期胃癌患者的临床病理特点及术后5年生存率进行回顾性分析.结果进展期胃印戒细胞癌75例,多见于中老年女性（70.0%）,胃中部多发（46.7%）.肿瘤大小、淋巴结转移、肝脏转移、腹膜转移等方面与进展期胃非印戒细胞癌相比差异无统计学意义（P＞0.05）;大体分型以BorrmannⅢ型、Ⅳ型多见（P＜0.01）,且浸润深度T3、T4比胃非印戒细胞癌多见（P＜0.01）;行根治性手术后5年生存率为44%,与其他类型进展期胃癌根治性手术后5年生存率相比差异无统计学意义（P＞0.05）.结论进展期胃印戒细胞癌与其他组织学类型的胃癌相比恶性程度无差异.