In response to a request from a national professional society regarding the use of procalcitonin in the clinical management of adult and pediatric patients with suspected local or systemic infection, a systematic review of comparative studies (randomized controlled trials and nonrandomized studies) was conducted. The patient populations included critically ill adults with suspected sepsis or other serious bacterial infections, neonates with suspected early neonatal sepsis, patients with upper and lower respiratory tract infections, children with fever of unknown origin, and postoperative patients at risk of infection. Pregnant women, patients with absolute neutropenia and other immunocompromised populations (solid organ and stem-cell transplant recipients, patients with advanced HIV infection/AIDS), and patients with chronic infections such as infective endocarditis were excluded from this review. The systematic review included 18 reports of eligible studies in over 6,000 patients published between January 1, 1990, and December 16, 2011. Outcomes including antibiotic usage, mortality, morbidity, adverse drug effects of antibiotic therapy, and hospital or intensive care unit (ICU) length of stay were assessed. This summary, based on the full report of research evidence, is provided to assist in decisionmaking along with consideration of a patients values and preferences. However, reviews of evidence should not be construed to represent clinical recommendations or guidelines.

关键词：医药；治疗技术；抗生素治疗；降钙素原

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Lymphoepithelioma-like carcinoma of the skin (LELCS) is a rare cutaneous neoplasm microscopically similar to undifferentiated nasopharyngeal carcinoma. It is typically nonaggressive and is treated with wide local excision. However, we present a case of a patient with a regional recurrence and more aggressive LELCS with perineural invasion and positive margins for which he was treated with wide local excision followed by chemoradiation. We discuss the use of chemoradiation for this patient and review the literature, specifically pertaining to treatment of more aggressive cases of LELCS.

关键词：医药；治疗技术；皮肤淋巴上皮癌

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This study was an open-label, single-group, treatment-development project aimed at developing and testing a method for applying virtual reality exposure therapy (VRET) to active duty service members diagnosed with combat post-traumatic stress disorder (PTSD). Forty-two service members with PTSD were enrolled, and 20 participants completed treatment. The PTSD Checklist-Military version, Patient Health Questionnaire-9 for depression, and the Beck Anxiety Inventory were used as outcome measures. Of those who completed post-treatment assessment, 75had experienced at least a 50reduction in PTSD symptoms and no longer met DSM-IV criteria for PTSD at post treatment. Average PSTD scores decreased by 50.4, depression scores by 46.6, and anxiety scores by 36. Intention-to-treat analyses showed that statistically significant improvements in PTSD, depression, and anxiety occurred over the course of treatment and were maintained at follow up. There were no adverse events associated with VRET treatment. This study provides preliminary support for the use of VRET in combat-related PTSD. Further study will be needed to determine the wider utility of the method and to determine if it offers advantages over other established PTSD treatment modalities.

关键词：医药；治疗技术；应激障碍；暴露疗法

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Raman spectroscopy is an analytical technique recognised for its structural and conformational specificity. The efficient discrimination of molecular species by Raman is particularly potent for multidimensional microscopic imaging of complex biological environment, as demonstrated in the present book. The commonly admitted problem of Raman, low sensitivity, can often be circumvented due to high output instruments and via approaches like RRS (resonance Raman scattering), SERS (surface-enhanced Raman scattering), TERS (tip-enhanced Raman scattering) or CARS (coherent anti-Stokes Raman scattering). In contrast to the latter, RRS and SERS are realizable with less sophisticated set-up based on common Raman systems. Although more invasive than RRS, SERS provides better sensitivity and quenching of fluorescence. SERRS (surface-enhanced resonance Raman scattering) spectroscopy can be used in coupling with fluorescence and competes in selectivity and sensitivity with spectrofluorimetry. In the chapter below, we use recent applications made in our group to illustrate the use of Raman and SERRS spectral imaging for characterization of biological samples (animal subcutaneous tissue, human cancer cells) and pharmaceutical samples (microparticles for drug delivery, fibres for wound dressing). After a brief description of experimental details on spectral imaging, the chapter will focus on results concerning (i) biocompatible pharmaceutical materials made of alginates and (ii) anticancer drugs in pharmaceutical forms and in biological systems.

关键词：医药；药品；拉曼成像；化学成分

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Therapeutic options for patients suffering from end-stage renal disease have improved tremendously over the last decades and can be divided into three categories: hemodialysis, peritoneal dialysis and kidney transplantation. Transplantation remains the treatment of choice, however, lack of donor organs results in the necessity of performing -temporary-dialysis therapies of which hemodialysis is carried out in the majority of patients. To facilitate adequate hemodialysis therapy a reliable vascular access is mandatory and can be provided by either surgically connecting an artery with a vein (arteriovenous fistula), surgically connecting an artery with a vein using an interposition of prosthetic graft material (arterioven-ous graft) or a central venous catheter. This chapter shortly reviews the condition of end-stage renal disease after which history of vascular access, different options to create a vascular access, pre-operative work-up, surgical procedure, monitoring and usage, post-operative complications and the role of hemodynamics will be discussed. Finally, some future directions for vascular access creation and management will be identified.

关键词：医药；治疗技术；血液透析；血管穿刺

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Insomnia is a common complaint in the general population. Hypnotics are the most common treatment for insomnia, despite some unwanted effects such as tolerance and dependence. Cognitive Behavioral Therapy for Insomnia (CBT-I) was shown to be effective in the treatment of chronic insomnia. Recent studies comparing CBT-I treatment with hypnotics further demonstrated that the CBT-I treatment was at least as effective as hypnotics during acute treatment, and may be more effective than medication during long-term follow-ups. This chapter describes the role of neurophysiological and psychological factors in the regulation and dysregulation of sleep. Further, the rationales and procedures of CBT-I are introduced. Lastly, the application of CBT-I with modern information technologies is discussed.

关键词：医药；治疗技术；认知行为治疗；睡眠障碍

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In our research, in accordance with the traditional sand therapy practice usually held in Turpan areas, we built an indoor sand therapy laboratory in Xinjiang University. After heating the sand with a heater for one week, we obtained similar temperature in every layer of the sand to that in the sand therapy. Male rabbits were treated with the sand therapy and medication and compared with normal control. The blood, joint fluid and mechanical properties of the bones were compared. The comparison of the mechanical properties of the bone, as well as our clinical experience with the sand therapy shows the effectiveness of such a treatment.

关键词：医药；治疗技术；股骨治疗；维吾尔族砂疗法

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The traditional control of the dialysis session comes about by means of an open-loop system. At the beginning of the session some parameters are set, such as the kind of dialyzer, the blood flow, the ultrafiltration rate, the dialysate conductivity and the dialysate temperature. Generally speaking, these parameters are not modified unless there occur complications in the patient that call for adjustments to be made. The biofeedback concept, which is synonymous with a closed-loop control of biological variables, presupposes, on the other hand: the continuous measurement of a variable thanks to a specific sensor its evaluation by a sort of expert system - the so-called controller and a series of means - the actuators - that allow the behavior of the variable to be directly or indirectly influenced. In clinical practice, different biofeedback systems are emerging, addressed to the control of blood volume, body temperature, and blood pressure. Each one of these systems has been successfully utilized, especially in the management of "difficult" patients unstable from the hemodynamic point of view. However, the future will be an integrated system that sees a complex adaptive, multi-input, multi-output controller which, with a great simplicity of use and low costs, will allow renal replacement therapy to be increasingly physiological and more efficient.

关键词：医药；治疗技术；生物反馈；血液透析

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The circadian system in humans encompasses all organs, tissues and cells. Coordination of central and peripheral clocks and synchronization of cellular clocks within the brain regulate daily phases, neurophysiology and behavior. The mechanism of action of the circadian system is complex, but is centered on the paired structure of the suprachiasmatic nuclei (SCN) that serves as a pacemaker in humans. Light adjusts the phase of the SCN oscillator to the environmental light-dark cycle. Light therapy has been developed for clinical use and many apparatus and parameters have been extensively studied. Bright light therapy is the treatment of choice for seasonal affective disorder and circadian rhythm sleep disorders. Cumulative studies support the efficacy of light therapy for some clinical conditions which are characterized by seasonality or disrupted circadian rhythms. The benefit of light therapy is significant and warrants further clinical studies to optimize the treatment effect.

关键词：医药；治疗技术；光线疗法；睡眠障碍

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RCT Systems led a team that included Creative Energy Solutions, and NDI Engineering in the development of an Advanced Energy Storage Module (ESM) for the Office of Naval Research (ONR) under a Broad Agency Announcement (BAA) contract for a DDG 51 Fuel Efficiency Demonstrator. The project demonstrated a modular 600kW ESM in December 2010. These modules could be combined into a 3 MW system to allow DDG 51 single generator operations, providing full ship backup power for up to 10 minutes with significant fuel savings. These savings are dependent on the ship operating profile. The BAA assumed 4,000 hours per year per ship of single generator operations. Based on that estimate, the system could facilitate savings of approximately 8000 BBL of Fuel/ship/year, or up to approximately $1.3M/ship/year in direct fuel savings at Jan 2012 DLA Fuel Rates of $160/bbl. This equates to approximately 30direct savings in the ships electric plant fuel usage during peace time cruise and an 8savings in overall ships fuel usage based on Navy Incentivized Energy Conservation (I-ENCON) reports. DoD has mandated the use of Fully Burdened Fuel Cost (FBFC) in all future acquisition decisions. FBFC savings could be as high as $3-5M/ship/year in FY-12 Dollars. We estimate that hardware costs alone could be recouped in approximately 2 years based on FBFC savings. Navy testing at NSWCCD SSES DDG-51 Land Based Engineering Site (LBES) is ongoing, and it is planned to install the ESM in a DDG-51 Class ship in summer/fall of 2012 for an at sea demonstration. The Navy is currently determining the total energy required to be available to satisfactorily de-risk single generator operations on DDG-51 Class ships. While designed for DDG 51, the modular system is potentially adaptable to all Navy and commercial ships, and supports the Next Generation Integrated Power System (NGIPS) Architecture.

关键词：储能；船舶；电力生产；节能；燃气轮机；发电机；锂电池

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