Informatics and the Clinical Laboratory

The nature of pathology services is changing under the combined pressures of increasing workloads, cost constraints and technological advancement. In the face of this, laboratory systems need to meet new demands for data exchange with clinical electronic record systems for test requesting and results reporting. As these needs develop, new challenges are emerging especially with respect to the format and content of the datasets which are being exchanged. If the potential for the inclusion of intelligent systems in both these areas is to be realised, the continued dialogue between clinicians and laboratory information specialists is of paramount importance. Requirements of information technology (IT) in pathology, now extend well beyond the provision of purely analytical data. With the aim of achieving seamless integration of laboratory data into the total clinical pathway, ‘Informatics’ – the art and science of turning data into useful information – is becoming increasingly important in laboratory medicine. Informatics is a powerful tool in pathology – whether in implementing processes for pathology modernisation, introducing new diagnostic modalities (e.g. proteomics, genomics), providing timely and evidence-based disease management, or enabling best use of limited and often costly resources. Providing appropriate information to empowered and interested patients – which requires critical assessment of the ever-increasing volume of information available – can also benefit greatly from appropriate use of informatics in enhancing self-management of long term conditions. The increasing demands placed on pathology information systems in the context of wider developmental change in healthcare delivery are explored in this review. General trends in medical informatics are reflected in current priorities for laboratory medicine, including the need for unified electronic records, computerised order entry, data security and recovery, and audit. We conclude that there is a need to rethink the architecture of pathology systems and in particular to address the changed environment in which electronic patient record systems are maturing rapidly. The opportunity for laboratory-based informaticians to work collaboratively with clinical systems developers to embed clinically intelligent decision support systems should not be missed.     

Why is it crucial to reintegrate pathology into cancer research?

The integration of pathology with molecular biology is vital if we are to enhance the translational value of cancer research. Pathology represents a bridge between medicine and basic biology, it remains the gold standard for cancer diagnosis, and it plays an important role in discovery studies. In the past, pathology and cancer research were closely associated; however, the molecular biology revolution has shifted the focus of investigators toward the molecular alterations of tumors. The reductionist approach taken in molecular studies is producing great insight into the inner workings of neoplasia, but it can also minimize the importance of histopathology and of understanding the disease as a whole. In turn, pathologists can underestimate the role of molecular studies in developing new ancillary techniques for clinical diagnosis. A multidisciplinary approach that integrates pathology and molecular biology within a translational research system is needed. This process will require overcoming cultural barriers and can be achieved through education, a more effective incorporation of pathology into biological research, and conversely an integration of biological research into the pathology laboratory.     

人干细胞实验动物嵌合体模型的研究进展

动物模型是疾病研究、发病机制、药物治疗的必要工具,目前一些困扰人类健康的重大疾病如艾滋病、乙型肝炎等因为还没有能反映人类疾病发病机理的理想动物模型。人干细胞是能在体外长期培养的、高度未分化的全能细胞系,亚全能细胞系和分化的干细胞等。如果能将人的干细胞成功移植入实验动物体内形成人源化嵌合体动物,有希望为艾滋病、肝炎等的研究制备适当的模型。人类干细胞在动物中的移植研究中主要的实验动物是绵羊,小鼠等,本文介绍了人干细胞在动物体内移植的研究进展。     

Incidence of tuberculosis,hepatitis, brucellosis,and shigellosis in British medical laboratory workers.

A retrospective postal survey of 21 000 medical laboratory workers in England and Wales showed 18 new cases of pulmonary tuberculosis in 1971, a five-times increased risk of acquiring the disease compared with the general population. Technicians were at greatest risk, especially if they worked in morbid anatomy departments. Of the 35 cases of hepatitis, the technicians were again the occupational group most likely to acquire the disease. Microbiology staff were twice as likely to report shigellosis as those in other pathology divisions but only one case of brucellosis was reported in the whole laboratory population. A similar survey carried out in 1973 of 3000 Scottish medical laboratory workers corroborates the results from England and Wales. Medical laboratory workers continue to experience a considerable risk of developing an occupationally acquired infection. Improvements in staff safety and health care seem to be necessary.     

Medicine through the artist's eyes: before, during, and after the Holocaust

Pre-Holocaust German art celebrates the doctor as a hero, triumphant over disease and poor hygiene. It emphasizes the ontological conception of disease and the ability of medicine to cure pathology or remove it. Some New Objectivity artists question this conceptualization by pushing it to the extreme of realistic representations. However, the clinical encounter has virtually disappeared from post-Holocaust art. Medicine is depicted in three main ways: as an ambiguous and alien Faustian craft; with a focus on holistic notions of healing, thus avoiding biomedicine altogether; or with a focus on the subjective experience of illness, thus ignoring the interaction between medicine and the diseased person.     

Traceability, reference systems and result comparability

The standardisation of measurements is of high priority in laboratory medicine, its purpose being to achieve closer comparability of results obtained using routine measurement procedures. At present, there is international cooperation in developing reference measurement systems (reference methods, reference materials, and reference laboratory networks) for analytes of clinical significance. These reference systems will reduce, wherever possible, measurement uncertainty and promote the comparability of results. The implementation of measurement traceability through the reference system provides one of the most important tools that supports the standardisation process in laboratory medicine. It aims to achieve result comparability regardless of the measurement procedure (test kit) and the clinical laboratory where analyses are carried out. The aim of this review is to discuss some concepts related to the achievement of standardisation by the implementation of a metrologically-correct measurement system and to provide some examples that illustrate the complexity of this approach and the impact of these activities on patient care.     

提高检验医学本科实习生综合素质探讨

随着生物医学技术、计算机技术、物理化学技术的迅速发展,临床医学对检验医学提出了更高的要求。作为实验室工作人员,在保证结果准确的基础上,还应对临床医生及病人提出的疑问给予合理、正确地解释。此外,还应该具备和临床医生进行交流,以及合理处理病人投诉的能力。五年制检验医学本科生是检验医学的主力军,培养高素质的检验医学本科生,对检验医学的发展将起关键性作用。     

Perspectives on the relevance of the circadian time structure to workplace threshold limit values and employee biological monitoring

The circadian time structure (CTS) and its disruption by rotating and nightshift schedules relative to work performance, accident risk, and health/wellbeing have long been areas of occupational medicine research. Yet, there has been little exploration of the relevance of the CTS to setting short-term, time-weighted, and ceiling threshold limit values (TLVs); conducting employee biological monitoring (BM); and establishing normative reference biological exposure indices (BEIs). Numerous publications during the past six decades document the CTS substantially affects the disposition – absorption, distribution, metabolism, and elimination – and effects of medications. Additionally, laboratory animal and human studies verify the tolerance to chemical, biological (contagious), and physical agents can differ extensively according to the circadian time of exposure. Because of slow and usually incomplete CTS adjustment by rotating and permanent nightshift workers, occupational chemical and other contaminant encounters occur during a different circadian stage than for dayshift workers. Thus, the intended protection of some TLVs when working the nightshift compared to dayshift might be insufficient, especially in high-risk settings. The CTS is germane to employee BM in that large-amplitude predictable-in-time 24h variation can occur in the concentration of urine, blood, and saliva of monitored chemical contaminants and their metabolites plus biomarkers indicative of adverse xenobiotic exposure. The concept of biological time-qualified (for rhythms) reference values, currently of interest to clinical laboratory pathology practice, is seemingly applicable to industrial medicine as circadian time and workshift-specific BEIs to improve surveillance of night workers, in particular. Furthermore, BM as serial assessments performed frequently both during and off work, exemplified by employee self-measurement of lung function using a small portable peak expiratory flow meter, can easily identify intolerance before induction of pathology.     

提高检验医学本科实习生综合素质探讨

随着生物医学技术、计算机技术、物理化学技术的迅速发展,临床医学对检验医学提出了更高的要求。作为实验室工作人员,在保证结果准确的基础上,还应对临床医生及病人提出的疑问给予合理、正确地解释。此外,还应该具备和临床医生进行交流,以及合理处理病人投诉的能力。五年制检验医学本科生是检验医学的主力军,培养高素质的检验医学本科生,对检验医学的发展将起关键性作用。     

The ferret, Mustela putorius furo, as a new species in toxicology.

Comprehensive studies on the haematology, urine chemistry, serum chemistry and gross pathology have been carried out and reported. Seasonal weight changes were confirmed and were initiated, together with sexual activity, when ferrets were brought in to a constant temperature (18-19 degrees C) and 14-hour daylight cycle during the winter months. Levels of haemoglobin, erythrocytes and haematocrit were higher than in most common laboratory species. Similarly, serum electrolytes and glucose levels were higher than in Wistar rats or beagle dogs. Ovaries, uteri and testes displayed a seasonal maturation and atrophy. All other parameters were similar to common laboratory species.     

The Edinburgh intercalated honours BSc in pathology: evaluation of selection methods,undergraduate performance,and postgraduate career.

In a study of 60 students who entered the intercalated honours BSc course in pathology at the University of Edinburgh over 10 years the conventional criteria of academic excellence and motivation were shown to be appropriate for the selection of honours students. When compared with classmates who did not take the intercalated year but who had shown similar high academic ability in the preclinical course the students who had taken the honours BSc did better in the remainder of the undergraduate curriculum. Of 42 honours students, 18 (43%) entered academic careers, particularly in pathology and medicine, but there was no observed tendency for students without honours BSc to do so. Although it is impossible to establish a causal relation between taking the honours course and subsequent academic distinction, the results suggest that the intercalated honours BSc in pathology serves a useful function in introducing able students into academic careers. The findings justify the financial support made available to such students during their intercalated year by the Medical Research Council and the Scottish Education Department.     

Pathology,proteomics and the pathway to personalised medicine

Introduction: As we move from a discovery to a translational phase in proteomics, with a focus on developing validated clinical assays to assist personalized medicine, there is a growing need for strong bidirectional interactions with the clinical pathology community. Thus, while on one hand the proteomics community will provide candidate biomarkers to assist in diagnosis, prognosis, surveillance, identification of individualized patient medication, and development and validation of new assays for diagnostic use, on the other the pathology community will assist with specific tissue identification and selection (e.g. laser capture microdissection, tissue sections for MS imaging), biobanking, validation of emerging automated histopathology techniques, preparation and classification of relevant patient medical reports, and assisting with the optimization of experimental design for clinical trials.

Areas covered: Here we discuss these topics with a particular emphasis on recent publications and relevant initiatives and outline some of the hurdles that still remain for personalized medicine.

Expert commentary: It is clear that effective crosstalk between the proteomics and pathology communities will greatly accelerate crossover of candidate biomarkers to personalized medicine, which will have significant benefits not only for patient wellbeing, but also the global healthcare budget. However, analysis of the big data generated may become rate-limiting.     

Stimulation of B lymphocytes,macrophages, and dendritic cells by protozoan DNA

This review summarizes recent work from our laboratory demonstrating the activation of B lymphocytes, macrophages and dendritic cells by DNA from three different protozoan parasites of cattle and humans that is qualitatively similar to the now well-described effects of CpG-containing bacterial DNA. This novel mechanism of protozoan parasite recognition by the innate immune system could facilitate recovery from acute infection or contribute to infection-related pathology.     

Transmission, diagnosis, and recommendations for control of Pseudoloma neurophilia infections in laboratory zebrafish (Danio rerio) facilities

The microsporidium Pseudoloma neurophilia represents a considerable challenge for laboratory zebrafish (Danio rerio) facilities. In 2010, P. neurophilia infections were diagnosed in zebrafish from 74% of the facilities that submitted fish to the Zebrafish International Resource Center (ZIRC) pathology service, and this organism remains the most commonly diagnosed pathogen in submitted fish. Accordingly, many of the ZIRC pathology service consultations deal with control and prevention of microsporidiosis. Here we describe observations and experiments performed at the ZIRC elucidating aspects of P. neurophilia transmission in zebrafish colonies. We then review current knowledge about P. neurophilia transmission and diagnosis. Considering this information, we present recommendations for control of P. neurophilia in zebrafish facilities.     

Auditory neuroplasticity,hearing loss and cochlear implants

Data from our laboratory show that the auditory brain is highly malleable by experience. We establish a base of knowledge that describes the normal structure and workings at the initial stages of the central auditory system. This research is expanded to include the associated pathology in the auditory brain stem created by hearing loss. Utilizing the congenitally deaf white cat, we demonstrate the way that cells, synapses, and circuits are pathologically affected by sound deprivation. We further show that the restoration of auditory nerve activity via electrical stimulation through cochlear implants serves to correct key features of brain pathology caused by hearing loss. The data suggest that rigorous training with cochlear implants and/or hearing aids offers the promise of heretofore unattained benefits.     

The evolution of Brazilian studies on helminths and the Escola tropicalista bahiana (Bahia Tropical School) (1866-1892)

In the mid nineteenth century, laboratory research in embryology, development, ecology and pathogeny of helminths unexpectedly resulted in a change in the explication of the etiology of some human pathology that was traditionally attributed to environmental factors. The new postulates of the parasitology of helminths put in question the traditional explications as well as the recognized authorities in the fields of clinical medicine, hygiene, and of medical geography, affecting not only the traditional circles where the innovations were discussed, but also the institutions that controlled and validated medical knowledge. From the beginning of the decade of the 1860s, a group of Brazilian medical doctors, initially led by Otto Wucherer, took part in this scientific movement that had an important impact on the area of the domestic and international academic medicine. The causality of known diseases, such as intertropical hypoemia, hematochyluria and elephantiasis, became the focus of intense debate between 1866 and 1892. By the end of this period, the field of helminthic parasitology had available well-established methodological and conceptual criteria and the role of Ankylostomum duodenale and of Wuchereria bancrofti in the production of those diseases was fully accepted.     

专业认证对医学检验专业本科教育改革的推动作用研究

医学检验是临床医学与医学实验技术相结合的一门学科,是医学领域中不可或缺的重要组成部分。医学检验专业起步晚、发展快,自创办以来便面临诸多困难与挑战,2012年全国医学检验专业本科教育实施大改革后,寻找合理的教学方法、探索本专业未来的发展道路更是当务之急。虽然我国医学专业认证起步不久,但专业认证已成为高等医学教育发展的必然趋势。结合医学检验专业目前面临的问题以及专业认证的特点,对医学检验实行专业认证将有助于保障检验医学教育质量,深化教学改革,实现人才培养与社会需求接轨,促进检验专业走向国际化。     

Systems biology, connectivity and the future of medicine

The concept of systems-based strategies in medicine is emerging, with systems pathology guiding an understanding of the multidimensional aspects of disease system fingerprints and systems pharmacology providing insight into dynamic system responses upon (multiple) drug perturbations. Knowledge of the changes of system characteristics during disease progression creates a framework for the design of novel combinatorial treatment strategies. Such a systems-based, combinatorial-therapies approach readdresses the value of the synergistic actions of components of treatments based on natural products and highlights new methodology to study multidimensional intervention via reversed-pharmacology.     

Development of third-stage Physaloptera larvae from Crotalus viridis rafinesque, 1818 in cats with notes on pathology of the larvae in the reptile. (Nematoda, Spiruroidea)

The prairie rattlesnake, Crotalus viridis, was found to be commonly infected with third-stage Physaloptera larvae. A total of 112 larvae were fed to 3 laboratory raised cats. Adult worms recovered 42 and 59 days postinfection were identified as P. rara. Observations were made on the pathology of the larvae in the snake.