信息管理系统对医院药品管理规范化的作用及意义

目的：评价血清中甲状腺特异性抗体的存在对乳腺癌患病风险的影响,为评估乳腺癌的预后及制定治疗方案提供理论依据。方法：计算机检索Medline（1950~2012）、EMBASE（1949~2012）、Pubmed（1946~2012）、Current Contents Connect（1998~2012）和Google Scholar（1992~2012）等英文数据库。收集关于甲状腺特异性抗体与乳腺癌（Breast Cancer, BC）相关性分析的横断面研究或队列研究。按Cochrane 系统评价方法,评价所纳入研究的文献质量,有效数据采用RevMan5.2 软件进行系统评价。结果：最终纳入6 项研究,共计6945 例患者。系统评价结果显示：乳腺癌的风险会随血清中甲状腺特异性抗体（包括甲状腺过氧化物酶抗体anti-TPO 和甲状腺球蛋白抗体anti-TG）的存在而增加（anti-TPO OR 2.51,95%CI： 1.94-3.25;anti-TG 2.67, 95%CI： 1.65-4.33）。结论：乳腺癌的风险会随血清中甲状腺特异性抗体的存在而增加,甲状腺特异性抗体可能为乳腺癌预后的评估以及治疗原则的制定提供理论基础。     

Recovery and Identification of Anaerobes: a System Suitable for the Routine Clinical Laboratory

A system for the isolation of anaerobes based upon the use of reducible solid media is described. Plates of reducible media prepared and stored aerobically were reduced before use by incubation in a GasPak jar for 24 h. Clinical specimens for culture were carefully selected. The value of Amies transport medium was confirmed. Selective and nonselective formulations of reducible media were used for primary isolation. Abbreviated identification schemes based in part on gas-liquid chromatography are presented. The suitability of this system for improving the recovery and identification of anaerobes in a routine clinical laboratory is documented.     

“教学、实践、科研、临床”四位一体的医学遗传学教学体系建设探索与实践

医学遗传学课程介于基础医学和临床医学之间,是一门应用性很强的学科,在现代医学教育体系中有着重要的地位。教学团队在多年的医学遗传学教学实践中,在建设省级精品课程的过程中,构建了“教学、实践、科研、临床”四位一体的医学遗传学教学体系,主要内容包括“课堂教学、社会实践、科学研究、临床应用”四者之间相互渗透、相互补充、相互促进,以课堂教学为基础,用社会实践补充教学,科学研究提升教学,临床应用促进教学。“四位一体”教学体系为基础课程与临床课程的有机整合探索了一条切实可行的路子。实施几年来,课程建设收到了良好效果,学科团队科研水平、社会声誉、医疗服务能力也有明显提高。     

Prototype of a Fully Automated Device for Determination of Bacterial Antibiotic Susceptibility in the Clinical Laboratory

A completely automated system for the performance of antibiotic susceptibility tests in the clinical laboratory is described. With a modicum of personnel involvement, data on 40 specimens tested against 13 antibiotics are obtained every hour after an initial 3-hr period. The step by step explanation of the functioning of this prototype system, based on a thoroughly tested manual model, is presented. The system compares well with the standard diffusion test and has a potential for application to other endeavors of the clinical microbiology laboratory with a comparable saving in time and labor.     

VITEK-2 compact全自动微生物鉴定仪对葡萄球菌鉴定能力的评价

目的评价VITEK-2 compact全自动微生物鉴定仪对葡萄球菌的鉴定能力。方法收集从我院病人标本中分离的葡萄球菌81株。常规细菌培养后,用VITEK-2 compact和API Staph系统进行检测,以API Staph系统为参照,评价VITEK-2 compact的优势和不足。结果 VITEK-2 compact和API Staph系统的总体鉴定符合率为95.1%,其中金黄色葡萄球菌的鉴定符合率为100%,凝固酶阴性葡萄球菌的鉴定符合率为90.5%。结论 VITEK-2 compact鉴定系统能够满足临床工作的需求,其中对金黄色葡萄球菌的鉴定率较高,在进行凝固酶阴性葡萄球菌鉴定时有一定的局限性,需要其他方法予以补充。     

Risk prediction for clinical phenotype in myotonic dystrophy type 1: data from 2,650 patients

Myotonic dystrophy type 1 (DM1) is a multisystem disorder that affects skeletal and smooth muscle as well as the eye, heart, endocrine system, and central nervous system. DM1 is caused by expansion of a CTG trinucleotidedaggerrepeat in the gene DMPK. Clinical findings in DM1 span a continuum from mild to severe. Although the CTG repeat correlates with the disease phenotype, caution is used in predicting disease severity on the basis of CTG repeat number. This study reports an extensive genotype-phenotype study to evaluate the clinical validity and clinical utility of the molecular genetic test. Data were analyzed by multiple logistic regression, used to estimate the odds ratio (OR) and correlation coefficients for patients phenotype in respect to the categorical variables expansion class, gender, familiarity, and the continuous variables age and disease duration. We assessed disease expression by clinical evaluation and the molecular genetic test in 2,650 patients identified by accurate clinical diagnosis and family segregation. We were able to estimate OR and correlation coefficients for patients phenotype according to CTG number. A genotype-phenotype correlation was established to derivate a clinical predictive risk on the basis of molecular data. This study demonstrates that measurement of triplet expansions in patients' DNA can be considered as a useful tool for DM1 phenotype assessment and presymptomatic testing.     

全膝关节置换术治疗类风湿性关节炎的临床效果分析

目的:探讨全膝关节置换术对类风湿性关节炎的临床疗效。方法:回顾性分析2012年10月至2014年1月在我院接受全膝关节置换术的80例风湿性关节炎患者的临床资料。采用HSS评分标准对膝关节疼痛情况进行评价,根据膝关节活动度(ROM)评价膝关节置换术的临床效果,观察患者术后并发症的发生情况,采用SF-36健康量表评估患者术后的生活质量。结果:患者术后膝关节疼痛评分低于术前(P0.05);患者术后膝关节活动度高于术前,且膝关节伸直和最大屈曲状态均优于术前(P0.05);术后膝关节冠状面和矢状面的畸形率均低于术前,差异具有统计学意义(P0.05);患者术后生存质量明显高于术前,差异具有统计学意义(P0.01)。术后发生感染2例,下肢深静脉血栓3例,膝前区疼痛2例,经对症治疗均获得缓解。结论:全膝关节置换术治疗类风湿性关节炎具有显著的临床效果,值得推广应用。     

Quantitative trait loci affecting clinical mastitis and somatic cell count in dairy cattle

Norway has a field recording system for dairy cattle that includes recording of all veterinary treatments on an individual animal basis from 1978 onwards. Application of these data in a genome search for quantitative trait loci (QTL) verified genome-wise significant QTL affecting clinical mastitis on Chromosome (Chr) 6. Additional putative QTL for clinical mastitis were localized to Chrs. 3, 4, 14, and 27. The comprehensive field recording system includes information on somatic cell count as well. This trait is often used in selection against mastitis when direct information on clinical mastitis is not available. The absence of common QTL positions for the two traits in our study indicates that the use of somatic cell count data in QTL studies aimed for reducing the incidence of mastitis should be carefully evaluated. Received: 9 May 2001 / Accepted: 6 July 2001     

Personalized diagnosis by cached solutions with hypertension as a study model

Statistical modeling of links between genetic profiles with environmental and clinical data to aid in medical diagnosis is a challenge. Here, we present a computational approach for rapidly selecting important clinical data to assist in medical decisions based on personalized genetic profiles. What could take hours or days of computing is available on-the-fly, making this strategy feasible to implement as a routine without demanding great computing power. The key to rapidly obtaining an optimal/nearly optimal mathematical function that can evaluate the "disease stage" by combining information of genetic profiles with personal clinical data is done by querying a precomputed solution database. The database is previously generated by a new hybrid feature selection method that makes use of support vector machines, recursive feature elimination and random sub-space search. Here, to evaluate the method, data from polymorphisms in the renin-angiotensin-aldosterone system genes together with clinical data were obtained from patients with hypertension and control subjects. The disease "risk" was determined by classifying the patients' data with a support vector machine model based on the optimized feature; then measuring the Euclidean distance to the hyperplane decision function. Our results showed the association of renin-angiotensin-aldosterone system gene haplotypes with hypertension. The association of polymorphism patterns with different ethnic groups was also tracked by the feature selection process. A demonstration of this method is also available online on the project's web site.     

Measurement of multi-segment foot joint angles during gait using a wearable system

Usually the measurement of multi-segment foot and ankle complex kinematics is done with stationary motion capture devices which are limited to use in a gait laboratory. This study aimed to propose and validate a wearable system to measure the foot and ankle complex joint angles during gait in daily conditions, and then to investigate its suitability for clinical evaluations. The foot and ankle complex consisted of four segments (shank, hindfoot, forefoot, and toes), with an inertial measurement unit (3D gyroscopes and 3D accelerometers) attached to each segment. The angles between the four segments were calculated in the sagittal, coronal, and transverse planes using a new algorithm combining strap-down integration and detection of low-acceleration instants. To validate the joint angles measured by the wearable system, three subjects walked on a treadmill for five minutes at three different speeds. A camera-based stationary system that used a cluster of markers on each segment was used as a reference. To test the suitability of the system for clinical evaluation, the joint angle ranges were compared between a group of 10 healthy subjects and a group of 12 patients with ankle osteoarthritis, during two 50-m walking trials where the wearable system was attached to each subject. On average, over all joints and walking speeds, the RMS differences and correlation coefficients between the angular curves obtained using the wearable system and the stationary system were 1 deg and 0.93, respectively. Moreover, this system was able to detect significant alteration of foot and ankle function between the group of patients with ankle osteoarthritis and the group of healthy subjects. In conclusion, this wearable system was accurate and suitable for clinical evaluation when used to measure the multi-segment foot and ankle complex kinematics during long-distance walks in daily life conditions.     

Randomised controlled trial of computer-held medical records in hypertensive patients.

A total of 278 hypertensive patients in three clinics were randomly allocated to have their medical records held in a computer system (136) or on standard hospital notes (142). For the computer system the doctor completed a structured input form, and the information on symptoms, physical findings, and diagnoses was more complete than that in the standard notes. This resulted in certain symptoms and risk factors being recognised more often when the computer system was used. The hypertension clinics'' routines were not disrupted by the introduction of a computer-held system, and follow-up consultation times were not affected by the type of records kept, although the first consultation took eight minutes longer when computer documents were completed. The patients remained in the trial for one year and clinical management was assessed from blood pressure control, drop-out rates, and the frequency of performing investigations. These estimates of management showed no significant difference between the two groups, but the attempt to tailor the computer system to help management made the system acceptable to the doctors using it. The computer system continues to be used and is providing data for research into hypertension.     

Accelerating Translational Research by Clinically Driven Development of an Informatics Platform–A Case Study

Translational medicine is becoming increasingly dependent upon data generated from health care, clinical research, and molecular investigations. This increasing rate of production and diversity in data has brought about several challenges, including the need to integrate fragmented databases, enable secondary use of patient clinical data from health care in clinical research, and to create information systems that clinicians and biomedical researchers can readily use. Our case study effectively integrates requirements from the clinical and biomedical researcher perspectives in a translational medicine setting. Our three principal achievements are (a) a design of a user-friendly web-based system for management and integration of clinical and molecular databases, while adhering to proper de-identification and security measures; (b) providing a real-world test of the system functionalities using clinical cohorts; and (c) system integration with a clinical decision support system to demonstrate system interoperability. We engaged two active clinical cohorts, 747 psoriasis patients and 2001 rheumatoid arthritis patients, to demonstrate efficient query possibilities across the data sources, enable cohort stratification, extract variation in antibody patterns, study biomarker predictors of treatment response in RA patients, and to explore metabolic profiles of psoriasis patients. Finally, we demonstrated system interoperability by enabling integration with an established clinical decision support system in health care. To assure the usefulness and usability of the system, we followed two approaches. First, we created a graphical user interface supporting all user interactions. Secondly we carried out a system performance evaluation study where we measured the average response time in seconds for active users, http errors, and kilobits per second received and sent. The maximum response time was found to be 0.12 seconds; no server or client errors of any kind were detected. In conclusion, the system can readily be used by clinicians and biomedical researchers in a translational medicine setting.     

Diversity of Virulence Phenotypes among Type III Secretion Negative Pseudomonas aeruginosa Clinical Isolates

Pseudomonas aeruginosa is a frequent cause of acute infections. The primary virulence factor that has been linked to clinical disease is the type III secretion system, a molecular syringe that delivers effector proteins directly into host cells. Despite the importance of type III secretion in dictating clinical outcomes and promoting disease in animal models of infections, clinical isolates often do not express the type III secretion system in vitro. Here we screened 81 clinical P. aeruginosa isolates for secretion of type III secretion system substrates by western blot. Non-expressing strains were also subjected to a functional test assaying the ability to intoxicate epithelial cells in vitro, and to survive and cause disease in a murine model of corneal infection. 26 of 81 clinical isolates were found to be type III secretion negative by western blot. 17 of these 26 non-expressing strains were tested for their ability to cause epithelial cell rounding. Of these, three isolates caused epithelial cell rounding in a type III secretion system dependent manner, and one strain was cytotoxic in a T3SS-independent manner. Five T3SS-negative isolates were also tested for their ability to cause disease in a murine model of corneal infection. Of these isolates, two strains caused severe corneal disease in a T3SS-independent manner. Interestingly, one of these strains caused significant disease (inflammation) despite being cleared. Our data therefore show that P. aeruginosa clinical isolates can cause disease in a T3SS-independent manner, demonstrating the existence of novel modifiers of clinical disease.     

Evaluating the success of blood transfusion with erythrocytes preserved in different ways

In a clinical study 18 patients with an indication to polytransfusion were examined by reason of secondary anaemias in diseases of the haemopoietic system. The efficiency of transfusion on the basis of body height, body mass and sex of the patients and the blood volume resulting from it as well as the exact amount of haemoglobin provided by stored blood and the increase of HB post transfusionem connected with it were found to be the criteria for the success of a transfusion. However, selected clinical parameters (LDH, Hbe, potassium, bilirubin) were constantly checked. The following values for the average efficiency of transfusion were found 16 hours post transfusionem: in washed erythrocyte concentrate 77%; in erythrocyte concentrate c. b. c. 45%; in erythrocyte concentrate GK 36%. Therefore, special emphasis is placed on an accompanying control of haemotherapy.     

A semiautomatic image analyzing system based on an APPLE II or IIe personal computer

A new semiautomatic image analyzing system based on an APPLE II or IIe personal computer is described. The configurations of the hardware and software are extensively explained. The possibilities of applying the system are demonstrated by different examples taken from various projects in biological research and clinical pathology. The system is designed to fulfil the following requirements: (1) stepwise realization as a unit-by-unit system according to individual needs and interests, (2) acquisition and calculation of morphometric parameters, (3) provision of solutions for the greatest possible number of given problems in clinical and experimental pathology, (4) direct connection of the system to host computers for on-line data transfer and evaluation, and (5) optimum cost-benefit ratio by manifold application possibilities for the individual hardware and software elements. The advantages of the unit-by-unit system with personal computers outweigh in many respects the disadvantages (for example, increased file handling and limited capacity) in comparison with the closed automatized image evaluation system, particularly with regard to costs, flexibility and compatibility. The system is being further developed in collaboration with Kontron Bildanalyse GmbH, Eching/Munich, FRG.     

Automation of routine clinical chromosome analysis. II. Metaphase finding

Metaphase finding is an essential activity in chromosome analysis, and there is much to gain from its automation. This paper describes software for automatic metaphase finding developed for use as part of a routine clinical chromosome analysis system, principally for samples from blood and amniotic fluid. Since the metaphase finding and analysis programs were intended to be used widely in clinical laboratories, cost and portability were important design features. The metaphase finder has been implemented on a moderately priced, general-purpose image analyzer (Magiscan 2), which controls a standard research microscope with motorized stage and focus. Metaphases are detected using fast gray-level processing on whole fields of view, followed by binary processing to produce a figure of merit for each detected object. Clinical experience has shown that this ability to rank detected objects on the basis of their suitability for analysis is a critical feature in determining the usefulness of an automatic metaphase finder.     

Comparison of culture and biochemical tests with PCR for detection of Brachyspira hyodysenteriae and Brachyspira pilosicoli

Traditional culture and biochemical tests (CBT) were compared with PCR for sensitivity and detection of Brachyspira hyodysenteriae and Brachyspira pilosicoli in seeded faeces and clinical samples from diarrhoeic pigs. A duplex PCR system was developed based on primers detecting the tlyA-gene of B. hyodysenteriae and the 16S rRNA-gene of B. pilosicoli. Sensitivities for the PCR system were determined on seeded faeces, using DNA that had been recovered from primary cultures or extracted directly from faeces. Compared to CBT, PCR applied to DNA extracted directly from faeces lowered the sensitivity by a factor of 1000 to 10,000. B. hyodysenteriae and B. pilosicoli detection was compared for CBT and PCR using 200 clinical samples. CBT detected more B. hyodysenteriae isolates in the clinical samples than PCR, but fewer B. pilosicoli positive samples. An atypical strongly haemolytic isolate was detected only by CBT.