Efficacy,effectiveness, and expected treatment response in psychotherapy

This article provides a summary of "The Evaluation of Psychotherapy: Efficacy, Effectiveness, and Patient Progress" (Howard, Moras, Brill, Martinovich, & Lutz, 1996) and an introduction to the "patient profiling" method. First, the difference between the two main approaches to treatment research in psychotherapy, efficacy research and effectiveness research, are discussed. Next, the idea is introduced that both types of treatment-focused research strategies need to be supplemented by a patient-focused research strategy. The concept of patient profiling is presented as an application of such a patient-focused research strategy. The usefulness of patient profiling for monitoring and evaluating individual patients' progress in ongoing psychotherapy as well as for clinical decision making is described. An expression of the personal and professional impact of Ken Howard on the author is provided.     

Three-dimensional cephalometry using individual skeletal laser technology models.

When planning operations on the facial skull, transversal asymmetries of the maxillo-mandibular complex cannot be adequately assessed using conventional two-dimensional (2D) x-ray cephalometry. On eight patients who presented with facial skull asymmetries, a three-dimensional (3D) laser technology model (LTM) using CT data was fabricated. Five sagittal plane points and six symmetry points were marked on the LTM, measured with the FlashPoint 3-D Digitizer and then geometrically converted, such that using the sagittal plane points, sella, basion, and nasion, a method could be developed that allowed the localization of each spatial point in the three symmetry planes. Thus one could quantitatively record a patient's specific facial skull asymmetry in all three planes and a 3D measurement became feasible. Based on the measurements, the asymmetry could be assessed with respect to the sagittal, vertical, and horizontal planes. With the 3-D LTM Digitizer measuring system, the surgeon now had precise numerical information regarding the symmetry ratios of the skull at his disposal, information that would have been difficult to evaluate solely using a model analysis. The results from this study show that our measuring system is applicable and useful for complex maxillofacial asymmetries. The planning of surgical interventions was optimized because precise numerical values regarding the degree of the asymmetry were available. With the 3-D LTM Digitizer measuring system, cephalometric analysis of complex asymmetries in the three spatial planes can be pragmatically supported.     

Outcomes management,expected treatment response,and severity-adjusted provider profiling in outpatient psychotherapy

To make use of psychotherapy research in practice, therapists need real-time access to valid clinically relevant information about patients. The dose-effect and phase models of psychotherapy provide a theoretical background for empirically based psychotherapy management by describing the systematic nature of progress in therapy and guiding the selection of outcome criteria. Given this theoretical background, it is possible to derive appropriate models for monitoring cases in ongoing therapies (patient profiling) and identifying therapists' relative strengths and weaknesses (severity-adjusted provider profiling). These applied methods may be used to inform decision making in ongoing psychotherapies and to support supervision and clinical training.     

Assessing embryonic stem cell response to surface chemistry using plasma polymer gradients

The control of cell-material interactions is the key to a broad range of biomedical interactions. Gradient surfaces have recently been established as tools allowing the high-throughput screening and optimization of these interactions. In this paper, we show that plasma polymer gradients can reveal the subtle influence of surface chemistry on embryonic stem cell behavior and probe the mechanisms by which this occurs. Lateral gradients of surface chemistry were generated by plasma polymerization of diethylene glycol dimethyl ether on top of a substrate coated with an acrylic acid plasma polymer using a tilted slide as a mask. Gradient surfaces were characterized by X-ray photoelectron spectroscopy, infrared microscopy mapping and profilometry. By changing the plasma polymerization time, the gradient profile could be easily manipulated. To demonstrate the utility of these surfaces for the screening of cell-material interactions, we studied the response of mouse embryonic stem (ES) cells to these gradients and compared the performance of different plasma polymerization times during gradient fabrication. We observed a strong correlation between surface chemistry and cell attachment, colony size and retention of stem cell markers. Cell adhesion and colony formation showed striking differences on gradients with different plasma polymer deposition times. Deposition time influenced the depth of the plasma film deposited and the relative position of surface functional group density on the substrate, but not the range of plasma-generated species.     

胃十二指肠溃疡的临床外科手术治疗与进展

胃十二指肠溃疡（gastroduodenal ulcer，G-DU）是外科常见的多发性疾病，常常并发穿孔、出血、梗阻、瘢痕性幽门梗阻及癌变等。近年来纤维内镜、腹腔镜技术的应用，新型抗酸剂质子泵抑制剂和抗幽门螺杆菌（HP）药物的合理使用以及改良、扩大迷走神经切断术的应用都大大提高了对G—DU的治疗疗效。但是至今为止，虽然在临床应用了改良扩大迷走神经切断术，对G—DU外科手术治疗尚没有完美无缺的手术方法。药物治疗能否完全替代外科手术治疗上有不同意见。目前对G-DU不同术式的疗效争论不一，本文就G—DU的临床外科手术治疗与进展作一探讨。     

Evaluation of treatment response in patients with seasonal allergic rhinitis using domiciliary nasal peak inspiratory flow

BACKGROUND: Measurement of domiciliary nasal peak inspiratory flow rate (PIFR) may have a role in the objective assessment of treatment response in seasonal allergic rhinitis (SAR). OBJECTIVE: We wished to evaluate the relationship between domiciliary measurement of nasal PIFR and a variety of symptoms associated with rhinitis. METHODS: Thirty-eight nonasthmatic patients, mean age (SEM) 30 years (1.4), with symptomatic SAR were evaluated in a placebo-controlled, single-blind, double-dummy, three way parallel group study. Patients received oral cetirizine 10 mg once daily and were randomized to receive, in addition, either: (i) intranasal mometasone furoate 200 microgram (n = 14); (ii) oral montelukast 10 mg (n = 11); or (iii) placebo (n = 13). All treatments were given once daily for 4 weeks and were preceded by a 1 week placebo period. Domiciliary diary cards were used to record morning (am) and evening (pm) domiciliary nasal PIFR and symptom (nasal, eye, throat) scores and impact on daily activity. A total daily symptom score was then calculated from the sum of these separate symptom scores. RESULTS: Baseline values for symptom scores and PIFR after placebo run-in were not significantly different when comparing the three groups. After 4 weeks of active treatment, there were significant (P < 0.05) improvements in nasal symptoms, total daily symptoms and PIFR with all treatments, with there being no significant confounding effect of pollen count, when analysed as a covariate. There were significant (P < 0.01) correlations for nasal symptom scores vs PIFRam (r = - 0.51) and PIFRpm (r = - 0.56), and similarly for daily activity vs PIFRam (r = - 0.42) and PIFRpm (r = - 0.48). CONCLUSIONS: These results suggest that domiciliary measurements of nasal peak flow correlate significantly with symptoms of seasonal allergic rhinitis and may therefore be a potentially useful objective short-term marker of treatment response.     

On the status of individual response specificity

The concept of physiological individual response specificity (IRS) was critically discussed. A review of empirical studies focused on IRS magnitude, stability, and personality correlates. Using difference scores, an average of 33% of the participants showed a significant IRS. IRS stability was found in only 15% of the participants. In some studies, IRS incidence was associated with neuroticism or stress coping styles. We suggest that the IRS concept should include not only purely constitutional but also situational and psychological determinants. Predictions from this revised biopsychological model were tested with a data set comprising 48 healthy male participants who completed six tasks, which were replicated three times in 1-week intervals. At Session 1, 21% of the participants displayed a significant IRS. IRS stability was found in only 8% of the participants. Participants with a significant IRS at Session 1 reported higher levels of fear (anger and happiness as covariates) and of pounding heart. Between-session IRS (trait-IRS) but not within-session IRS (state-IRS) was associated with trait anxiety.     

Wegener's granulomatosis--disease course and treatment response of 18 patients

Eighteen patients (12 female) with Wegener's granulomatosis (WG) treated from 1982-2001 were studied. Mean duration of patients' symptoms prior to diagnosis was 13.5 months, and mean age 41.2. Lung biopsy confirmed WG in 5 patients, nasal biopsy was made in 12, endobronchial in 3. In 11 of 14 patients cANCAs were found. Prednisone and 2 mg/kg/day doses of oral cyclophosphamide were used to treat 17 patients, prednisone was used alone for 1. Patients with severe symptoms were given i.v. 'pulse' methylprednisolone. Mean duration of treatment was 34.8 months and of follow-up, 71.9 months. A total of 4 patients died: 3 from complete renal failure. Four patients still undergo treatment, improving markedly. Complete remission was achieved in 6 patients. A total of 3 patients relapsed and are recently treated. In another one chronic renal failure developed. Three of them had moderate symptoms at diagnosis but were treated inadequately. In conclusion: manifestation of WG and severity of symptoms may be different among patients. ANCA is not universally present in all patients with WG. The absence of ANCA does not exclude WG diagnosis. Complete remission can be achieved in WG patients, including the severely ill, if adequate therapy is given. Moderate symptoms at presentation do not justify less intensive treatment.     

Institutionahzation and parole behavior: Assessing the influence of individual and family characteristics

Using statistical controls for selection bias, the present study evaluates the relative impact of institutional and noninstitutional programs on two indicators of parole behavior, parole maladjustment and parole violations. Multiple regression models assessing program effects included individual and family predictors of parole behavior identified in previous literature. Placement in alternative programs was inversely associated with both parole outcomes; larger effects for program placement were observed for models predicting parole violations. Nonprogram variables, including younger commitment age, lower IQ, and more family problems, were consistently associated with adverse parole outcomes. Significant interaction effects suggested that the effect of programs on parole behavior depends on a youth's age and level of family problems. The family problems index was the single most important predictor of parole behavior. Despite specific differences, there was considerable overlap between models explaining the two parole outcome measures. Implications for research and intervention are discussed.     

Predictors of ovarian response: progress towards individualized treatment in ovulation induction and ovarian stimulation

Ovarian stimulation is applied in the clinic to restore mono-ovulatory cycles in anovulatory women (ovulation induction) or to induce the development of multiple dominant follicles for assisted reproduction. Ovarian response is the endocrine and follicular reaction of the ovaries to stimulation. Achieving an appropriate ovarian response to anti-estrogens or exogenous gonadotrophins is central to ovulation induction and ovarian stimulation protocols. However, achieving an adequate response, without cycle cancellation or adverse events related to under- or over-stimulation, is complicated by high intra- and inter-individual variability. To predict each patient's ovarian response to medication for ovarian stimulation and to individualize the starting dose of exogenous gonadotrophin or the need for exogenous luteinizing hormone, various clinical, endocrine, ovarian ultrasonographic and genetic characteristics have been explored. Some of these features have been incorporated into prediction models. In this review, the methodology behind predictive factors and prediction models and their potential clinical applicability across ovulation induction and ovarian stimulation are explored.     

Humoral immune response to individual Yersinia enterocolitica antigens in patients with and without reactive arthritis.

The IgG, IgA and IgM antibody responses to individual Yersinia enterocolitica antigens were analysed by immunoblotting in 10 patients with reactive arthritis and 11 patients with enterocolitis caused by Y. enterocolitica serotype 0:3. The IgG antibody response was directed against partly different antigens compared with IgA. The expression of these antigens varied with bacterial culture conditions. The IgG and IgM antibody responses in the early stages of infection (less than or equal to 3 weeks) were directed against a large number of antigens. The IgA response was more selective, with antibodies against 240, 48 and 34.5 kD antigens dominating. IgA antibodies against eight antigens ranging in molecular weight from 52.5 to 105 kD were seen exclusively among arthritic patients. When following the IgA antibody response in the two groups of patients for up to 993 days, antibodies tended to persist to selective antigens. However, these antigens varied to some extent between patients, but the persistence was seen both among arthritic and non-arthritic patients. Persistent antibodies to 240, 48 and 34.5 kD antigens were most common. IgA antibodies to a 112 kD antigen were more prevalent and persisted longer in patients with arthritis compared to patients with uncomplicated infection.     

DSM criteria for major depression: evaluating symptom patterns using latent-trait item response models

BACKGROUND: Expert committees of clinicians have chosen diagnostic criteria for psychiatric disorders with little guidance from measurement theory or modern psychometric methods. The DSM-III-R criteria for major depression (MD) are examined to determine the degree to which latent trait item response models can extract additional useful information. METHOD: The dimensionality and measurement properties of the 9 DSM-III-R criteria plus duration are evaluated using dichotomous factor analysis and the Rasch and 2 parameter logistic item response models. Quantitative liability scales are compared with a binary DSM-III-R diagnostic algorithm variable to determine the ramifications of using each approach. RESULTS: Factor and item response model results indicated the 10 MD criteria defined a reasonably coherent unidimensional scale of liability. However, person risk measurement was not optimal. Criteria thresholds were unevenly spaced leaving scale regions poorly measured. Criteria varied in discriminating levels of risk. Compared to a binary MD diagnosis, item response model (IRM) liability scales performed far better in (i) elucidating the relationship between MD symptoms and liability, (ii) predicting the personality trait of neuroticism and future depressive episodes and (iii) more precisely estimating heritability parameters. CONCLUSIONS: Criteria for MD largely defined a single dimension of disease liability although the quality of person risk measurement was less clear. The quantitative item response scales were statistically superior in predicting relevant outcomes and estimating twin model parameters. Item response models that treat symptoms as ordered indicators of risk rather than as counts towards a diagnostic threshold more fully exploit the information available in symptom endorsement data patterns.     

慢性支气管炎动物模型的研究与进展

背景：近年来,许多学者纷纷通过构建和研究动物模型来模仿慢性支气管炎的病理特征,以进一步阐明其发病的遗传背景、诱发因素、发病机制。 目的：对国内外诱导慢性支气管炎动物模型的现状及新进展作一综述。 方法：应用计算机检索CNKI和Pubmed数据库中1999年1月至2011年10月关于慢性支气管炎动物模型的文章,在标题和摘要中以“慢性支气管炎,动物,模型”或“chronic bronchitis,animals,model”为检索词进行检索。最终选择24篇文献进行综述。 结果与结论：建立慢性支气管炎动物模型的方法主要有化学药物法、细菌感染法、被动吸烟法和复合方法等,每种方法各有其优缺点,目前尚无一种公认最理想的方法,还有待于进一步的研究和探索。     

Internal models of target motion: expected dynamics overrides measured kinematics in timing manual interceptions

Prevailing views on how we time the interception of a moving object assume that the visual inputs are informationally sufficient to estimate the time-to-contact from the object's kinematics. Here we present evidence in favor of a different view: the brain makes the best estimate about target motion based on measured kinematics and an a priori guess about the causes of motion. According to this theory, a predictive model is used to extrapolate time-to-contact from expected dynamics (kinetics). We projected a virtual target moving vertically downward on a wide screen with different randomized laws of motion. In the first series of experiments, subjects were asked to intercept this target by punching a real ball that fell hidden behind the screen and arrived in synchrony with the visual target. Subjects systematically timed their motor responses consistent with the assumption of gravity effects on an object's mass, even when the visual target did not accelerate. With training, the gravity model was not switched off but adapted to nonaccelerating targets by shifting the time of motor activation. In the second series of experiments, there was no real ball falling behind the screen. Instead the subjects were required to intercept the visual target by clicking a mousebutton. In this case, subjects timed their responses consistent with the assumption of uniform motion in the absence of forces, even when the target actually accelerated. Overall, the results are in accord with the theory that motor responses evoked by visual kinematics are modulated by a prior of the target dynamics. The prior appears surprisingly resistant to modifications based on performance errors.     

Polyvinyl alcohol cryogel: Optimizing the parameters of cryogenic treatment using hyperelastic models

The PVA gels obtained by freezing/thawing cycles of PVA solutions, also called cryogels, exhibit non-linear elastic behavior and can mimic, within certain limits, the behavior of biological soft tissues such as arterial tissue. Several authors have investigated the effects of cryogenic processing parameters on the Young’s modulus. However, an elastic modulus does not describe the non-linearity of the cryogel’s stress–strain response. This study examines the non-linear elastic response of PVA cryogel under uniaxial tension and investigates how processing parameters such as the concentration, the number of thermal cycles, and the thawing rate affect this response. The relationship between the coefficients of the material model and the processing parameters was interpolated to find the set of parameters that would best approximate the elastic response of healthy porcine coronary arteries under uniaxial tension.     

肺癌合并肺部真菌感染的诊疗进展

随着肺癌发病率的增加,肺癌合并肺部真菌感染的病人在临床上已经越来越常见,因其临床表现缺乏特异性又合并原发疾病,针对这部分的病人在早期诊断、治疗上仍然存在一定的困难.本文将从常见致病真菌、影像学表现和常用抗真菌药物、抗真菌治疗的研究进展等方面讨论肺癌病人合并肺部真菌感染的诊断和治疗.