The Hierarchical Clustering of Clinical Psychology Practicum Competencies: A Multisite Study of Supervisor Ratings

Competency evaluation rating forms are widely used to assess a range of global and specific psychology practitioner competencies during and at the end of clinical placements. Surprisingly, there is little research examining the dimensional structure or the hierarchical clustering of items on these ratings. The current, multisite study examined supervisor ratings of clinical psychology trainees (N = 204) on the Clinical Psychology Practicum Competencies Rating Scale (CΨPRS). Based on the proximity criterion chosen, hierarchical clustering yielded either nine clusters or four super clusters: Good Practitioner Attributes and Conduct, Scientist Practitioner and Professional Management, Assessment and Intervention, and Psychological Testing. The study also tracked the developmental trajectory of competency attainment. CΨPRS ratings differentiated groups between early but not between later stages of training. Measurement issues and implications for training and practice are discussed.     

以反晕征为主要CT表现的继发性肺结核影像特征分析

目的探讨以反晕征为主要CT表现的继发性肺结核的影像学特征,以提高对此类不典型肺结核的诊断水平。方法搜集经临床证实的以反晕征为主要CT表现的继发性肺结核患者12例,结合相关文献,对其影像学和临床资料进行回顾性分析和总结。结果共发现反晕征病灶97个:上叶63个(以尖、后段为主),下叶背段19个,其余肺叶、肺段15个;1例单发,其余11例多发。CT或HRCT表现:12例均见反晕征,呈类圆形、边界较清,内见结节、树芽征,外环不光滑。病灶周围可见卫星灶和其他间质性改变,包括:小叶内网格状阴影(12/12)、微结节(12/12)、树芽征(10/12)、小叶间隔增厚(7/12)、细支气管壁增厚(6/12)和磨玻璃样密度影(5/12)。伴随征象:空洞1例(痰菌阳性),胸腔积液2例,实变3例,胸膜受累3例,钙化4例。结论以反晕征为主要CT表现的继发性肺结核患者影像学具有一定特征性,结合临床资料,可对其诊断和鉴别诊断提供一定帮助。     

Wart with Depigmented Halo and Generalized Vitiligo

Depigmented haloes sometimes appear around melanocytic tumors or non-melanocytic tumors, but coexistence of warts and depigmented haloes is extremely rare. We report here an unusual case of warts accompanied by depigmented haloes and subsequently-triggered generalized vitiligo. A 55-year-old Japanese man presented with a 3-year history of brown nodules on the back, upper eyelid and dorsum of the left hand. Depigmented haloes appeared around the noldules and then gradually spread over a wide area, resulting in the development of generalized vitiligo. He had no history of antecedent treatment for these lesions before consultation. Histopathologically, the lesion showed papillomatosis and hyperkeratosis with lymphocytic exocytosis into the epidermis, which compatible to warts. Based on these clinical and histopathologic findings, a diagnosis of warts with depigmented halo and subsequently-triggered generalized vitiligo was made. None of the warts had resolved spontaneously after the appearance of haloes, and the depigmented haloes and generalized vitiligo remain unchanged.     

Distinctive features of degenerating Purkinje cells in spinocerebellar ataxia type 31

Spinocerebellar ataxia type 31 (SCA31) is an autosomal dominant form of pure cerebellar ataxia that is caused by a disease‐specific insertion containing penta‐nucleotide repeats (TGGAA)_n. Neuropathologically, cerebellar Purkinje cells are preferentially affected and reduced in number in SCA31, and they are often surrounded by halo‐like amorphous materials. In the present study, we performed neuropathological analyses on two SCA31 brains, and discussed the serial morphological changes of Purkinje cells in SCA31.We found that bent, elongated, often folded nuclei were observed frequently in degenerating Purkinje cells with the halo‐like structure. Conversely, Purkinje cells without this structure developed marked atrophy with severely slender and condensed nuclei. On the basis of these pathological findings, we propose two different processes for Purkinje cell degeneration in SCA31, namely, shrinkage of Purkinje cells with or without the halo‐like amorphous materials. The former, but not the latter, was considered to be specific to SCA31. Correspondingly, fragmentation of the Golgi apparatus was observed more frequently in Purkinje cells with the halo‐like structure than in those without this structure. We consider that the profound nuclear deformity and fragmentation of the Golgi apparatus are closely linked with the formation of the halo‐like structure in SCA31.     

Reverse halo sign on chest imaging in a renal transplant recipient

Without proper treatment, the mortality of pulmonary mucormycosis is nearly 100%. Although the diagnosis is often made histologically, it can be suspected when patients have a reverse halo sign on computed tomography (CT) of the chest, along with the right clinical findings. We describe the case of a woman 7 months post renal transplant who presented with fevers, malaise, and chest pain. Her chest CT revealed a round, focal area of ground‐glass attenuation surrounded by a complete rim of consolidation in the left upper lobe, consistent with the reverse halo sign. Pulmonary mucormycosis was diagnosed by transbronchial lung biopsy. She was successfully treated with combined medical and surgical therapies. In the context of this case, we provide a brief review of the diagnosis of pulmonary mucormycosis, with a focus on radiographic and pathologic findings.     

The immunopathology of regression in benign lichenoid keratosis, keratoacanthoma and halo nevus

BACKGROUNDRegression is a phenomenon present in a variety of cutaneous lesions. It is likely that similar immunologic mechanisms explain the phenomenon of spontaneous regression occurring in the various lesions.METHODSTwenty-seven specimens, nine each of halo nevus, keratoacanthoma, and benign lichenoid keratosis, including three examples each of predominantly early, mid, and late regression were examined with antibodies to HLA-II, CD1a, CD3, CD4, CD8, CD20, CD34, CD56, and CD68.RESULTSEpidermotropism of inflammatory cells, including CD1a positive, CD68 positive, CD3 positive, and CD8 positive cells, was present in benign lichenoid keratosis and keratoacanthoma, but not in halo nevus. In halo nevus, the nests of halo nevus cells tended to be infiltrated by CD1a positive, CD68 positive, CD3 positive, and CD8 positive cells. The blood vessels exhibited endothelial cell swelling with luminal narrowing and disruption within the dermis of all lesions. The CD1a positive cells were increased in number in lesional epidermis except in keratoacanthoma lesions where the density of CD1a positive cells was increased in the epithelial lip, but decreased within the epithelial portion of the keratoacanthoma proper. Conversely, the CD8 positive cells were scarce in the dermis below the epithelial lip of the keratoacanthoma, but increased in the dermis of the neoplastic epithelium. CD1a positive cells were also seen throughout the dermal portion of the lesion, particularly at the lesion base. In halo nevus, the CD1a positive cells and CD68 positive cells within the lesions were larger than those in non-lesional skin, indicating activation. The composition of the inflammatory infiltrate varied within each lesion type according to stage of regression, but T-lymphocytes predominated.CONCLUSIONCytotoxic T-cells may be the final common denominator of regression in benign lichenoid keratosis, keratoacanthoma, and halo nevus. In halo nevus, cytotoxic T-cells may play the predominant role in regression. In keratoacanthoma and benign lichenoid keratosis, cytotoxic T-cells play a pivotal role, but additional mechanisms may also be involved in the phenomenon of regression. Benign lichenoid keratoses progress through stages of regression accompanied by varying proportions of inflammatory cells, including CD3, CD4, and CD8 positive T-lymphocytes, natural killer cells, macrophages and Langerhans cells.     

颅盆牵引软组织松解加后路手术治疗重度脊柱侧弯36例观察

目的:评价颅盆环牵引软组织松解加脊柱后路手术治疗重度脊柱侧弯畸形的临床疗效.方法:回顾性分析颅盆牵引软组织松解加后路手术治疗重度脊柱侧弯36例的临床资料.36例患者均行颅盆环牵引,牵引过程中行凹侧软组织松解-胸廓成形术,经牵引脊柱畸形得到较理想矫正后行脊柱后路手术植骨融合内固定.治疗前后测量患者脊柱侧弯Cobb's角及身高,分别比较治疗前后的差异性.结果:36例患者均顺利完成手术,患者脊柱侧弯Cobb,s角由手术前的(95.9±28.4)°矫正至(35.2±12.3)°,矫正率63.3％;身高由手术前的132.7±15.4 cm增高至146.7±15.4 em,手术前后比较有显著性差异(P＜0.05).患者身体外形、行走姿势得到明显的改善,脊柱额状面失平衡得到明显的纠正.本组病例无脊髓神经损伤及肠系膜上动脉综合征等严重并发症发生.结论:对于重度脊柱侧弯患者,经颅盆环牵引凹侧软组织松解-胸廓成形术加后路手术治疗,可以提高患者手术耐受性,简化操作,预防并发症的发生,是一种安全有效的治疗方法.     

Treatment of halo nevus with a 308‐nm excimer laser: A pilot study

Background: The treatment of halo nevus is controversial and ranges from observation requiring no therapy to excision biopsy. Objective: To assess the efficacy of excimer laser for the treatment of halo nevus. Methods: Four patients with halo nevus on the face were treated by excimer laser three times a week until they achieved 75% pigmentation or a maximum of 36 treatment sessions. They were assessed visually by comparing photographs taken before and at the end of treatment. Results: Two patients re‐pigmented completely and two showed 80% pigmentation. The number of sessions ranged from seven to 35. The study is limited by the small number of patients. Conclusion: Treatment with the 308‐nm excimer laser may be an effective treatment of halo nevi located on the face.