临床科研数据库系统的现状与未来

临床科研数据库是开展临床研究的重要支撑平台,在临床真实世界研究快速发展的背景下引发了更多关注。本文总结了当前临床科研数据库的三种常见类型及特点,阐述了临床科研数据库系统从孤立系统向平台化发展的需求及技术架构演变,并从系统实现角度分析了主要的技术问题,提出与随访系统以及医疗业务信息系统的整合、围绕研究问题从原始数据直接提取科研数据的能力是未来临床科研数据库系统发展的重点。     

中国国家罕见病注册系统架构和数据质量控制及管理流程

中国国家罕见病注册系统(National Rare Diseases Registry System of China, NRDRS)是依托"十三五"国家重点研发计划精准医学专项"罕见病临床队列研究"项目,由北京协和医院负责牵头建设的国家级罕见病在线注册平台(www.nrdrs.org.cn),为中国罕见病事业的基础建设。罕见病病种繁多,注册数据来自真实世界复杂多样的临床场景,信息采集周期长,以存量数据为主,建立数据标准化规范难度很大。NRDRS平台管理组从三个方面逐步提升平台功能,加强数据质量控制:优化注册系统底层框架及管理功能;从多个环节加强数据质量控制并推进数据标准化;建立平台管理规范流程。迄今已有28个省、直辖市和自治区的85家协作单位的研究者基于NRDRS平台注册病例,涉及166种/类罕见病,已建立185个临床研究队列,登记病例共计6万余例。NRDRS平台的建立与发展不仅促进了中国罕见病研究协作网络和罕见病临床队列研究技术标准与管理规范的建立,同时为大型多中心、多病种临床研究的开展奠定了良好的基础。     

医疗设备共享管理系统的设计与实现

目的设计一个急救设备高效管理与临床科室共享调配相结合的医疗设备共享管理平台,利用大数据优化整合现有医疗资源,实现急救设备使用的全过程管理。方法结合我院现有的内部网络,依据需求分析并建立员工信息管理、设备信息管理、费用信息管理等五大模块,基于C/S架构、PHP+MySQL集成环境,自主研发设计并实现医疗设备的共享管理。结果通过对冀中能源峰峰总医院急救设备日常共享服务管理的实际应用与测试,该系统能很好地优化医院设备管理流程,极大地提高了设备管理人员工作效率,累计节约临床科室专职人员20余名,设备使用率最高增幅120%,总体故障率下降29%,累计为医院节约资金220余万元。结论运用智能化管理系统结合医疗设备的共享调配可以明显提高我院设备的使用率,信息化管理是医院精细化发展的必然结果。     

新型肿瘤靶标环状RNA的研究进展

环状RNA(circRNA)是内源非编码性RNA,多数circRNA被发现可通过发挥微小RNA(miRNA)海绵功能来调控基因表达,此外某些circRNA也会被翻译或与RNA结合蛋白互作发挥作用。circRNA广泛表达于组织和体液中,其表达量的改变与肿瘤的发生发展相关。circRNA的环化特性使其对核糖核酸酶R(RNase R)稳定而不易降解。由于circRNA稳定、种类丰富、可特异性调控肿瘤发生、在体液中高表达,因此有望成为肿瘤相关的诊断、预后和治疗靶标。目前对circRNA的认识相对较少,其发生机制和功能尚未完全解析,circRNA的注释也有待充实。本文总结了circRNA的发生机制、生物学功能和在肿瘤研究中的重要应用。     

基于TCGA数据库分析GTSE1基因在肺腺癌中的表达及意义

目的:探究G2/S期表达蛋白1（G2 and S phase-expressed protein1,GTSE1）在肺腺癌中的表达情况以及对预后的影响。方法:从癌症基因组图谱（TCGA）数据库中下载肺腺癌患者表达谱数据以及临床信息资料,分析GTSE1表达水平与临床指标信息之间的相关性及对预后的影响,并用Cox比例风险回归模型分析影响患者预后的因素。采用免疫组化检测14例肺腺癌肿瘤组织和13例癌旁组织中GTSE1表达水平。采用基因集富集分析方法（GSEA）预测GTSE1在肺腺癌中可能参与并调控的相关通路。结果:在TCGA数据中,在肿瘤组织样本中GTSE1基因表达情况明显高于正常组织（t=18.165,P<0.05）,且表达水平与肿瘤分级（?字2=17.543,P=0.001）、T（?字2=8.825,P=0.032）和N分期（?字2=12.138,P=0.001）之间有显著相关,GTSE1高表达患者的总生存期显著低于GTSE1低表达的患者（?字2=22.663,P<0.05）,单因素Cox分析提示肿瘤分级（HR=1.56,95%CI:1.33～1.83）、TNM分期（T:HR=1.60,95%CI:1.31～1.95;N:HR=1.70,95%CI:1.40～2.06;M:HR=1.83,95%CI:1.03～3.25）和GTSE1表达水平（HR=2.32,95%CI:1.62～3.30）可影响患者的总生存期（均P<0.05）。多因素Cox分析提示T分期（HR=1.646,95%CI:1.038～2.610,P=0.034）和GTSE1的表达水平（HR=1.830,95%CI:1.269～2.637,P<0.05）是影响肺腺癌患者总生存期的独立危险因素。GTSE1基因高表达的样本在细胞周期以及p53信号通路等9个通路基因集中富集（P<0.05,FDR<0.01）。结论:GTSE1在肺腺癌患者肿瘤组织中显著高表达,是肺腺癌患者的独立预后因素。     

Network pharmacology-based approach to investigate the mechanism of Huang-Lian-Jie-Du-Decoction for treatment of type 2 diabetes mellitus

Background: Although the benefits of Huang-Lian-Jie-Du-Decoction (HLJDD) on type 2 diabetes mellitus are noted, the material base and action mechanism remain unknown. This paper aim is to reveal the material base and action mechanism of HLJDD against type 2 diabetes mellitus in a system pharmacology framework. Methods:The compounds in HLJDD were first retrieved from the Traditional Chinese Medicine Systems Pharmacology database and analysis platform. Once retrieved, they were fed into the SwissTargetPrediction database to predict the interacting targets. Meanwhile, a human expression profile dataset was analyzed in the Gene Expression Omnibus database, and subsequently, the differentially expressed genes were compared to the HLJDD-related targets. We conducted a protein-protein interaction analysis, Kyoto Encyclopedia of Genes and Genomes pathway analysis, and Gene Ontology analysis to identify the potential active compounds and targets. Lastly, to verify the binding affinities of those compounds and targets, we performed molecular docking. Results: We obtained 15 key compounds, such as quercetin, epiberberine, and berberine, and 10 hub genes, such as IκB kinase-β and phosphatidylinositol 3-kinase regulatory subunit alpha. The top 10 enriched pathways were also found to be tightly related to type 2 diabetes mellitus, including insulin resistance and FoxO signaling pathway. Moreover, all the key compounds were found to bind well to the hub genes. Particularly for the target of IκB kinase-β, 11 out of 15 compounds bound to it with energies of相似文献   

Determinants of wait time for infant inguinal hernia repair in a Canadian children’s hospital

Background

Longer wait time for infant inguinal hernia (IH) repair is associated with higher complication rates. We wished to determine if socioeconomic and demographic factors influence wait times for IH repair.

Methods

Children < 2 years old with IH at a Canadian children’s hospital were retrospectively reviewed. Days from diagnosis to surgical consultation (W1) and from consultation to repair (W2) were collected along with demographic, medical, and socioeconomic data. Linear regression analysis was performed.

Results

A total of 131 patients were appropriate for analysis (82.4% male). Median distance to hospital was 27.5 km (IQR = 10.5–50.4) and median income was $34,477 (IQR = 30,127–41,986). Median W1, W2, and Wtotal (W1 + W2) were 24 (IQR = 8–48), 43 (IQR = 21–69) and 79 (IQR = 38–112) days, respectively. Wait times were shorter in infants who were male (p = 0.044), symptomatic (p < 0.001), diagnosed in the ED (p < 0.001), or had an incarcerated hernia (p = 0.006). They were longer for premature infants (p = 0.009) and those with significant comorbidities (p = 0.018). Neither income (p = 0.328) nor distance from hospital (p = 0.292) was associated with longer wait times.

Conclusion

Wait times for IH repair were appropriately influenced by medical risk factors. Income and distance to hospital did not appear to influence wait times. A population-based study is needed to determine if these findings reflect a general trend within the Canadian health care system.     

芬兰国家卒中数据库监测体系的回顾

芬兰通过患者个体水平的多个行政注册数据库之间的关联建立了国家卒中数据库
（PERFormance,Effectiveness,and Cost of Treatment episodes in Stroke,PERFECT）。卒中数据库可以系
统地评估卒中患者的治疗和结局以及卒中服务的结构和过程。与其他国家的卒中数据库相比,该卒
中数据库有较高的覆盖率和较完整的患者随访信息。该数据库的维持费用较低,通过利用国家行政
数据库开展卒中监测,不但节省了监测成本,得到较高的覆盖率和较高的长期随访率,同时对疾病负
担进行了综合监测。