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：治疗技术 透析

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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：康复计划；截肢；艺术假肢设备

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In October 2011, the Institute of Medicine (IOM) released the report Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Evaluating the Evidence, assessing the published evidence for the effectiveness of using cognitive rehabilitation therapy (CRT) to treat people with traumatic brain injury (TBI). TBI has gained increasing attention in the past 15 years because of its status as the signature wound of American military conflicts in Iraq and Afghanistan. Growing numbers of U.S. service members are suffering traumatic brain injuries and are surviving them, given that (a) the majority of traumatic brain injuries are mild and (b) lifesaving measures for more severe injuries have significantly improved. People with any level of injury can require ongoing health care in their recovery, helping them to regain (or compensate for) their losses of function and supporting their full integration into their social structure and an improved quality of life.

关键词：治疗技术；康复治疗(CRT)；创伤性脑损伤(TBI)

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Tamoxifen, the first targeted therapy, has shown great success in treating estrogen receptor (ER) positive breast cancer. However, both acquired and de novo resistance to this therapy prevents it from being effective in all situations. Multiple lines of evidence indicate that increased signaling through growth factor pathways, such as the IGF pathway, mediates resistance to tamoxifen. The link between ER and ICGF1R leads us to hypothesize that IGF system crosstalk with the ER contributes to tamoxifen resistance. Tamoxifen resistance has thus provided researchers with a reason to investigate other growth factor pathways involved in breast cancer. As new targeted therapies are being developed, it will be important to examine their benefit with existing therapies. In order to examine the effectiveness of anti-IGF1R inhibitors in vitro, tamoxifen resistant (TamR) cells were generated by culturing MCF-7L and T47D cells in the presence of 4-OH-tamoxifen for >6 months. TamR cells had dimished levels of IGF1R, with unchanged levels of insulin receptor (IR). Further, TamR cells failed to respond to IGF-I induced p-AKT activation, while retaining responsiveness to both insulin and IGF-II. Additionally, IGF-I failed to enhance the proliferation and anchorage-independent growth of TamR cells; however, both insulin and IGF-II were able to enhance proliferation in MCF anchorage-independent growth. An IGF1R antibody was effective in inhibiting signaling, anchorage-independent growth, and proliferation in MCF-7L cells, but had no effect in TamR cells. In contract, an IGF1R/TR tyrosine kinase inhibitor was effective in both MCF-7L and TamR cells. In a xenograft model, an IGF1R antibody was able to inhibit estrogen stimulated tumor growth, but had no additive effect when combined with tamoxifen treatment. Further, tamoxifen-treated xenografts had diminished IGF1R levels.

关键词：治疗计划；雌激素受体；乳腺癌

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关键词：医药；政策环境；市场行情；厂商动态；科技研发；国际资讯；行业数据；分析评论

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The National Institute on Disability and Rehabilitation Research (NIDRR) is one of the principal federal agencies supporting applied research, training, and development to improve the lives of individuals with disabilities. NIDRR's mission is to generate new knowledge and promote its effective use in improving the ability of persons with disabilities to perform activities of their choice in the community, as well as to expand society's capacity to provide full opportunities and accommodations for its citizens with disabilities. NIDRR aims to reach all disability types and age groups, and its mission is tied to long-term outcomes such as independence, community participation, and employment. Assessing the outcomes of research is a complex undertaking that can variably take into account the stated goals of the research, the contribution to the relevant field of research, the impact on the well-being of a particular population, or other related issues. The Government Performance and Results Act has led to a particular emphasis on establishing specific performance measures assessing the outputs of research programs. NIDRR takes pride in proactively establishing program performance measures focused on the quality of its grantee outputs, developing account ability data systems to track the results of those measures, and developing internal management systems to facilitate quality research. In 2009, NIDRR requested that the National Research Council form a committee to conduct a 'process evaluation' of aspects of its grant making and a 'summative evaluation' of the quality of grantee outputs. In addition, the committee was charged with assessing the methods it developed for conducting the summative evaluation and making recommendations for the conduct of future evaluations. The requested study was the most recent effort in a series of NIDRR-funded activities aimed at assessing and improving the agency's performance.

关键词：康复计划 进化 残疾

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The sympathetic nervous system (SNS) is a major pathway activated by exposure to emotional stressors. We have demonstrated SNS hard-wiring in the form of sympathetic nerve fibers in 4T1 mammary tumors, a mouse model of metastatic breast cancer. We established that 4T1 tumor cells do not express functional - or -adrenergic receptors (AR), the receptors activated by norepinephrine (NE), the neurotransmitter of the SNS. Yet, manipulation of sympathetic neurotransmission in vivo by chemical ablation of sympathetic nerves to deplete NE decreased F480+ tumor associated macrophages and reduced tumor weight. Furthermore, chronic treatment with desipramine (DMI), an antidepressant that elevates synaptic NE, increased 4T1 tumor growth, but not metastasis. DMI-induced tumor growth was not associated with increased tumor angiogenesis, and pro-tumor cytokines VEGF, IL-6, RANTES, and MIP-2 were reduced by DMI. To further dissect the tumor response to NE, mice were treated with selective AR agonists. The 2-AR agonist dexmedetomidine (DEX) increased tumor growth and metastasis in the absence of alterations in VEGF, IL-6, RANTES, and MIP-2. Treatment with the -AR agonists isoproterenol and salmeterol did not significantly alter tumor growth/metastasis. In DMI- and DEX-treated mice, tumor collagen microstructure was uniquely altered in 4T1 tumors, suggesting a novel stromal-mediated mechanism whereby elevated NE and stimulation of AR may increase tumor growth. These results suggest that NE-induced tumor growth is mediated by 2-AR activation, but other AR pathways activated by elevated synaptic NE may modulate the tumor-promoting effect of 2-AR activation. Understanding how AR pathways regulate breast tumor pathogenesis will lead to new therapies to inhibit tumor growth and metastasis.

关键词：治疗 交感神经

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The broad objective of the proposed study is to empirically evaluate the efficacy of a cognitive behavioral intervention, titled, Post Admission Cognitive Therapy (PACT), for military personnel psychiatrically hospitalized due to a suicide-related event with either a recent or a lifetime suicide attempt. The primary outcomes will be incidence of repeat suicide attempt(s) and number of days until a repeat suicide attempt. Secondary outcomes include psychiatric symptoms, repeat number of psychiatric hospitalization(s), hope for one s future, and acceptability of treatment. A multi-site, single-blind, randomized controlled trial will be the research design. A total of 218 individuals will be recruited from the inpatient psychiatric and traumatic brain injury (TBI) units at the Walter Reed National Military Medical Center and Fort Belvoir Community Hospital. Participants will be randomized into one of two conditions: (1) PACT + Enhanced Usual Care (EUC) or (2) EUC. The PACT+EUC condition will consist of six 60-90 minute individual cognitive behavioral therapy sessions administered over preferably three days during the inpatient stay and up to four telephone booster sessions. The EUC condition will consist of usual psychiatric care patients receive during their hospitalization, the assessment services provided by MA and/or PhD level clinicians, and case management services provided for one year by Bachelor s level research personnel. Follow-up assessments will be conducted at 1, 3, 6, and 12-month post discharge by blind PhD level clinicians.

关键词：治疗；试验；认知疗法；精神病症状

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The current proposal aims to explore the relationship between brain function and connectivity in selective pathways/circuits, neuropsychological functioning, and cognitive rehabilitation response in Veterans with both Traumatic Brain Injury (TBI) and Posttraumatic Stress Disorder (PTSD). Toward this end, we propose a randomized clinical trial involving a cognitive rehabilitation intervention that targets improved executive functioning, with the participation of N=100 Veterans diagnosed with both TBI and PTSD (n=50 experimental/n=50 control). We have just begun recruitment three months ago and enrolled n=15 dyads of veterans and family members at this point.

关键词：康复计划；脑损伤；康复治疗

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The rationale for using neurofeedback to affect changes in children on the autism spectrum is rooted in several assumptions. First, regions comprising the human mirror neuron system or MNS exhibit abnormal connections in ASD children. Second, the 8- 13 Hz mu rhythm oscillations over sensorimotor cortex are functionally linked to the MNS network. Third, modifying these oscillation dynamics via neurofeedback training induces neural plasticity. Finally, normalization of abnormal connectivity is reflected in positive behavioral, cognitive, and electrophysiological changes. Our results show behavioral improvements following training in all the subcategories of the ATEC, a validated measure of the efficacy of an intervention. Similarly, we report improvement in the three subscales in adaptive measures, as measured by the Vineland Adaptive Behavioral Scale. Finally, social interactions during daily living were assessed with the Social Responsiveness Scale and improvements noted with training. BOLD activation results indicate that both TD and ASD groups have activity in IFG, IPL, and STS areas during imitation and in the observation of hand movement, but these activations are significantly greater for the TD group. Furthermore, our results are consistent with anatomical findings that show regions in the ASD brain exhibiting overconnectivity and underconnectivity compared to the TD brain. Finally, we show that NFT produces increases in MNS activity and reductions in abnormal functional connectivities between MNS areas compared to the TD brain.

关键词：自闭症谱系障碍(ASD)；康复训练

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