关键词：医药；针灸；创伤后应激障碍；军事人员

查看摘要 索取原文[21页]

The U.S. military is providing amputees with state-of-the-art prosthetic devices. In addition to walking and changing direction, amputees must be able to manage uneven terrain, crowded environments, stairs, ramps, and hills. The largest problem for a lower extremity amputee is falls. Falling history and balance confidence are associated with reduced mobility capability and social activity. The goal of this research effort is to rehabilitate individuals with lower extremity amputations to reduce falls using a novel training method. The training program utilizes a microprocessor-controlled treadmill designed to deliver task-specific training perturbations. The training consists of six, 30 minute sessions delivered over a 2-week period. Trunk motion and velocity was assessed using a perturbation test in an immersive virtual environment, since trunk kinematics has been shown to determine fall likelihood. We have enrolled 14 research subjects at the Naval Medical Center San Diego. Mean trunk flexion angle and velocity significantly improved after participating in the training program. The improved performance was maintained up to 6 months. Subjects reported decreased uncontrolled and semi-controlled falls in their free-living environment outside of the research laboratory. These results indicate that task-specific training is an effective rehabilitation method to reduce falls in persons with lower limb amputations.

关键词：医药；康复技术；截肢；复健；军事人员

查看摘要 索取原文[8页]

Mild traumatic brain injury (mTBI) and post-traumatic stress disorder (PTSD) co-occur at a high rate in Soldiers and Veterans. Despite this, there is a paucity of evidence-based treatments for those dealing with mTBI/PTSD symptoms and their exacerbation by stress. Using a placebo-controlled, randomized, blinded design, the current study is testing the following hypothesis: active acupressure (more than Placebo) will reduce the adverse effects of stress in Veterans with co-occurring mTBI/PTSD, which will be evident in measures of anxiety, perceived stress, distress, psychiatric health, memory and in a laboratory stress task. Veterans have been recruited since regulatory approval was obtained (August 2012) and enrolled in the study in an ongoing manner, with several having already completed the study protocol or being in process. Because the study is ongoing, there are no data to report as of yet. The findings of the present study hold significant military significance: a safe, portable, low-cost, efficacious and accessible treatment strategy would benefit Veterans, family members and the military/VA health care systems. Results of the ongoing study will determine if acupressure is such a treatment strategy.

关键词：医药；创伤后应激障碍；精神病学；军事人员

查看摘要 索取原文[5页]

The hallmarks of the recent conflicts in Iraq (20032011) and Afghanistan (2001-present) are blast injuries and the psychiatric consequences of combat, particularly posttraumatic stress disorder (PTSD), the subject of this report. According to the American Psychiatric Associations Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), PTSD symptoms must be manifested in three clusters: 1. Persistent re-experiencing, such as recurrent thoughts, nightmares, and flashbacks; 2. Persistent avoidance of trauma-associated stimuli (for example, avoiding related thoughts, feelings, conversations, or places) and emotional numbing that was not present before the trauma; and 3. Persistent hyperarousal that may be manifested as hypervigilance, an exaggerated startle response, or difficulty in concentrating. Those symptoms must persist for at least a month and cause clinically significant distress or functional impairment. PTSD is unique among psychiatric disorders in that it is linked to a specific trigger--a traumatic event--such as combat, natural and accidental disasters, and victimization and abuse.

关键词：医药；军事人员；创伤后应激障碍；精神障碍

查看摘要 索取原文[415页]

The study was designed to identify clinically accessible molecular biomarkers of traumatic brain injury (TBI) prior to definitive clinical diagnosis using high throughput microRNA technology. Specifically, these studies were meant to identify, characterize, and validate microRNA biomarker species whose content in peripheral blood mononuclear cells (PBMC) could help to distinguish TBI cases from the Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) veteran population. During the past years, we conducted a Biomarker Discovery study using a high-throughput Array chip platform and identified 18 candidate TBI small RNA biomarkers. Using independent Q-PCR assays, we confirmed that 13 of these candidate small RNA biomarker species are, indeed, significantly down-regulated in PBMC of TBI compared to non-TBI control veteran cases. Additionally, we used unsupervised clustering analysis and demonstrated that the differential regulation of these small RNA biomarkers in clinically accessible blood cells is capable of distinguishing between TBI and non-TBI OEF/OIF veteran cases. Lastly, we identified a 3-biomarker panel capable of distinguishing TBI from non-TBI control veteran cases with 89accuracy 82selectivity and 78specificity. The majority of TBI cases in our biomarker study were co-morbid with PTSD, and our non-TBI control cases were selected to match for PTSD diagnosis. Thus, our identified panel of 13 small RNA biomarkers likely represents biological indices selective for TBI. During the past year, we recruited 13 new cases (6 TBI and 7 non-TBI cases). Together with the cases recruited in previous years, we currently have a total of 83 cases, comprised of 17 TBI and 66 non-TBI control cases, which are available for Biomarker Validation studies.

关键词：医药；个性化医疗；军事人员；创伤性脑损伤

查看摘要 索取原文[20页]

The U.S. military is currently fitting amputees with state-of-the- art prosthetic devices. In addition to walking and changing direction on a variety of surfaces, amputees must be able to manage uneven terrain, crowded environments, stairs, ramps, and hills. The largest problem for a lower extremity amputee is falls. Among individuals with a lower extremity amputation, 52reported having fallen in the previous 12 months, 49reported being fearful of falling, and 65had low balance confidence scores. Falling history and balance confidence are associated with reduced mobility capability and social activity. As a result, lower extremity amputees with limited balance and stability are at risk for diminished quality of life. The goal of this research effort is to rehabilitate lower extremity amputees to reduce falls using a novel training method. In this first year of the research effort, we have developed a novel experimental method to induce unexpected trips to amputees under controlled laboratory conditions. We have identified objective biomechanical variables that are causally related to the success or failure in avoiding a fall after a trip, objective tests to quantify functional outcomes, and a subject-specific questionnaire to determine if the training method is effective. Enrollment has begun. Our target is to deliver a quantitatively derived, deployment-ready, advanced gait rehabilitation system that can improve functional outcomes and/or shorten the time required for injured servicemen and women to return to active duty or to a productive civilian life.

关键词：医药；康复技术；截肢；复健；军事人员

查看摘要 索取原文[6页]

This project was focused on production of megakaryocytes and platelets from human pluripotent stem cells - originally human embryonic stem cells (hESC), but subsequently, as the technology became available, from human induced pluripotent stem cells (hiPSC). We developed a serum-free system, and also created our own cell-free extracellular matrix extracts instead of live feeder cells to support hESC and hiPSC growth and maintenance, followed by feeder cell-free cultures to create embryoid bodies, then mesenchymal cells, which then were induced to differentiate into functional megakaryocytes and platelets.

关键词：医药；人类胚胎干细胞；人类诱导多能干细胞；无血清培养

查看摘要 索取原文[6页]

Vestibular pathology has been documented following barotrauma and/or head acceleration associated with exposure to explosions. The usual symptoms include dizziness and headache, with dizziness and associated imbalance contributing disproportionately to disability. Several agencies have noted the need for better vestibular evaluation and rehabilitation following exposure to improvised explosive devices (IEDs). The authors asked subject matter experts to assist in formulating recommendations for initial assessment and rehabilitation of balance problems following IED exposure, focusing on strategies that are either available or in development. This report summarizes feedback obtained from approximately 50 vestibular researchers, scientific advisors, clinicians, and biomedical engineers working for government agencies, universities, clinics/hospitals, and businesses. Tests appropriate for early (post-injury) functional assessment in the military setting are considered, along with the optimal application of novel tactile balance feedback technologies being developed to augment vestibular rehabilitation.

关键词：医药；康复技术；创伤性脑损伤；前庭器官

查看摘要 索取原文[113页]

Posttraumatic osteoarthritis affects approximately 5.6 million Americans annually. Those affected are typically younger and more active than persons with primary osteoarthritis. Arthrodesis is the typical management option for persons with end-stage ankle and subtalar posttraumatic arthritis. Arthroplasty is typically reserved for elderly persons. The functional limitations resulting from any of these strategies make treatment of this young population challenging. Combat wounds frequently lead to severe lower extremity injuries. We present a series of patients with severe posttraumatic osteoarthritis of the ankle and subtalar joint after combat trauma. They were treated at our institution with an integrated orthotic and rehabilitation initiative called the Return To Run clinical pathway. This clinical pathway may serve as an alternative or adjunct to arthrodesis and arthroplasty for young patients with severe posttraumatic osteoarthritis of the ankle and subtalar joint.

关键词：医药；康复技术；骨关节炎；关节融合术；临床医学

查看摘要 索取原文[7页]

The overall aim is to conduct preliminary evaluations of new rehabilitation strategies and new functional assessment methods for homonymous hemianopia (HH) and spatial neglect (SN), disabling visual and cognitive perception conditions that commonly occur as a result of severe traumatic brain injury (TBI) and stroke. Both HH and SN prevent detection of objects on the affected side, resulting in unsafe walking and driving. Using realistic tasks in virtual environments representative of everyday mobility challenges we are evaluating a novel optical device expansion prism (EP) glasses - combined with a new computerized perceptual-motor training regimen in helping people with HH and SN detect and avoid obstacles on the affected side. In the first year we have made good progress in developing the training software and preparing the functional assessments, and have started recruitment. Specifically, we (1) obtained all necessary IRB approvals; (2) made excellent progress in developing and testing the training program and training task suite; (3) made excellent progress in preparing the functional assessments in the driving simulator and virtual mall that will be used to evaluate performance without and without the prism glasses before and after training; (4) evaluated mobile eye tracking technologies that will be used for an outdoor walking task; (5) began recruitment; (6) collected pre-pilot data from participants who did not meet the study criteria, and (7) enrolled 3 participants for the main pilot study. Results from the first participant who has completed the protocol are promising showing significantly improved detection rates and collision judgments with the EP-glasses after training.

关键词：医药；康复技术；创伤性脑损伤；功能恢复训练；损伤评估

查看摘要 索取原文[12页]