This article comes from WeChat public number: China News Weekly (ID: chinanewsweekly) , author: Liming Zi

“Pathological diagnosis is the gold standard for disease diagnosis”

At 3:50 in the morning of February 16th, the anatomy of the body of the first patient with New Crown Virus pneumonia in Wuhan was successfully completed at Wuhan Jinyintan Hospital. It was completed by Liu Liang, a professor of forensic pathology at Tongji Medical College of Huazhong University of Science and Technology, and his team. Hours later, they completed a second autopsy.

At present, two anatomical pathologies have been submitted for examination in order to reveal the pathogenesis, pathological characteristics and related clinical associations of New Coronavirus. This highly anticipated report is expected to be released in 10 days >.

“The first lung result of the anatomy of the remains has come out. You can see changes in the lungs with exudation and deterioration, but more information is needed to comprehensively judge the pathological situation.” Chinese pathologist, Southern Medical University pathology professor Ding Yanqing told China News Weekly that his team had completed the world during the 2003 fight against SARS Autopsy of the first SARS patient.

“We are still working, we need to concentrate.” At 10 am on the 18th, Liu Liang posted a “No interview or interruption” on his personal media account. He previously said in an interview with the Health Times, The anatomical work on February 16 was mainly based on material extraction. “The virus needs to be inactivated, so the tissue to be extracted should be bubbled. Next, the section will be observed under a microscope to see its cell structure and how the tissue structure has changed. “On the similarities and differences between the new crown virus infection and SARS, Liu Liang said that further microscopy and pathological and virological studies are needed.

Two consecutive autopsy cases in 18 hours

At 9 pm on February 15th, Liu Liang, who was waiting for a reply, suddenly received a call from Zhang Dingyu, the director of Wuhan Jinyintan Hospital, “There is one that can be dissected.” Liu Liang recalled, “the country, the province The municipal health and health committee broke the rules, acted first, and then issued a formal letter. ”

On the previous day, Liu Liang “called for the autopsy of dead individuals with new crown pneumonia as soon as possible” on his personal media platform. At 11 am on the 15th, Liu Liang received a reply from the State Administration of Health and Medical Services Administration and was invited to join the new crown At the meeting on the autopsy of pneumonia deaths, he “optimistically estimated that it will take 2-3 days for the autopsy to land.”

Notice came earlier than expected, and Liu Liang urgently arranged team members to come to the hospital from all corners of Wuhan. At the same time, Jinyintan Hospital specially vacated a clean room with negative pressure to ensure the dissection and prevent the virus from spreading.

“This autopsy was carried out so quickly. Thanks to the consent of the family members, we dedicated our silence to him before the autopsy. Liu Liang wrote.

Both patients come from the ward administered by the Shanghai Medical Team.

The first batch of Shanghai medical aid teams in Hubei was one of the earliest provincial teams to reach Wuhan. The counterparts supported Jinyintan Hospital, the leader of the medical team, and the deputy director of Shanghai First People’s Hospital, Zheng Junhua introduced that even though artificial labor was used during the treatment Some of the most advanced methods such as liver, artificial kidney, and ECMO still have difficulties in rescuing and died unfortunately. Understanding the pathogenesis is crucial for first-line treatment, and an autopsy report is urgently needed.

After the death of the first anatomy patient, Zheng Junhua’s team communicated for more than two hours. The family members signed the consent form after understanding the significance of the anatomy. In order to protect the privacy of the deceased and his family members, Zheng Junhua only revealed that the two deceased patients were both over 55 years old.

Wearing breathless protective clothing and waiting until more than 1 am, Liu Liang’s team started an autopsy. At 3:50, the first autopsy was successfully completed.

“Finally, I knew the strength of the isolation protective clothing. After wearing it for less than 10 minutes, I was sweating a lot. As a result, when I was able to work normally and easily, sweating like rain, breathing difficulties, my glasses and goggles were dim. Like the altitude sickness, the first case was mostly half-hearted, showing palpitation, dizziness, and hypoglycemia. On the one hand, it means that you are really old. But reallyExperience the hard work and dedication of medical staff. It is necessary to pay tribute to all ordinary front-line medical fighters! “Liu Liang wrote on his personal media platform.

After the first autopsy was over, Liu Liang went home and quarantined for more than 2 hours. He immediately summed up with the team members and reported the problems that could be improved in the autopsy process. At 11 am on the 16th, Liu Liang again received the notice from the director of Jinyintan Hospital, Zhang Dingyu, “another autopsy was needed.” He urgently recruited the team members and rushed to the hospital again. At 4:30 in the afternoon, the dissection began. Liu Liang felt so cold that he was soaked, and immediately went home to isolate himself again, and recorded the continuous work for 18 hours.

Pathological diagnosis is the gold standard for disease diagnosis

On the day Liu Liang issued a written appeal, there were a total of 63,946 confirmed diagnoses in the country, of which 1,382 people died. Compared with SARS in 2003, the clinical manifestations of severe patients with new coronary pneumonia are the disease progresses faster, and some patients have significant hypoxia development and severe heart injury. However, at the time, no systematic solid anatomy and disease were performed on dead individuals. Physical examination.

“If you want to better treat these severe and critically ill patients in the clinic, you need to know more about the pathogenesis and the physical condition of the patients. This requires basic research to keep up, which is Autopsy and pathology report . “Hu Ming, director of the Wuhan Pulmonary Hospital, said in an interview with China News Weekly.

After the outbreak of SARS in 2003, the pathogen was initially considered to be a “chlamydia” with little destructive power, but the patient was severely ill, had a high mortality rate, and the use of antibiotics was not effective. After completing the dissection of the first SARS deceased, Ding Yanqing, a professor of pathology at Southern Medical University, combined with the results of 4 autopsies performed at Southern Hospital at that time, comprehensively judged that the pathogen should be “virus”, which provided an important scientific basis for the treatment of SARS.

“Pathological diagnosis is the gold standard for disease diagnosis.” Ding Yanqing told China News Weekly that pathologists began calling for “case autopsy” in the WeChat circle of friends as early as around the Spring Festival. On January 29, Academician of the Chinese Academy of Sciences and Director of the Institute of Pathology, Army Military Medical University, Xiu Wu issued the “Recommendations on Carrying Out Autopsy Work for New Coronavirus Infection Death Cases” to the Chinese Center for Disease Control and Prevention, and the National Health and Medical Commission informed the country of the diagnosis There were 7711 cases with 170 deaths.

There are many problems in the clinical treatment of neocoronavirus pneumonia that have not been scientifically explained. Why the upper respiratory virus test is much lower than the lower breathRoad? What are the similarities and differences between the ground-glass pathology of the patient’s lungs and other viral pneumonia? What are the reasons and mechanisms for the rapid progress of the disease in the later stage?

“About the rapid progress of the disease and severe heart damage in the later stage, I discussed with Academician Xiu Wu, referring to the pathological results of SARS, which may be caused by cytokine storms.” Ding Yanqing explained that in 2003 he was the first in the UK The Journal proposed that “lung and immune organs are the main target organs attacked by SARS virus.” In 2006, it published “Studies on the Pathological Mechanism of SARS Immunity”, and proposed that “proinflammatory factors” overexpression and acute lung injury of SARS and multiple organs The damage is closely related, which is now called “ Cytokine Storm” . When the tissue cells are damaged, the body produces an excessive immune response and secretes a large amount of cytokines, which leads to degeneration and necrosis of the tissue cells of the body, enhanced vascular permeability, and extravasation of blood and plasma.

The cytokine storm will also initiate a large amount of nitric oxide release , which further dilutes the blood and destroys blood vessels, reducing blood pressure, leading to tissue hypoxia, hypotension, multiple organ dysfunction, and disseminated intravascular Coagulation.

“These require a certain number of autopsy pathological studies and comprehensive analysis.” Ding Yanqing said that unlike SARS, the onset of the new coronavirus pneumonia is long and the early symptoms are mild. For example, a case of sudden exacerbation and death after a period of treatment may reflect the overall situation of the epidemic more comprehensively.

According to Ding Yanqing, an academician of the Chinese Academy of Sciences Xi Xiuwu has set up a “tent-type” autopsy room in the Central Theater Hospital to comply with Class III standards for biosafety protection, in order to prepare for a better autopsy of new-type coronary pneumonia. “ China lacks an anatomical room for Class A infectious diseases. This issue is very urgent now. We do not know what the new crown virus will face afterwards, but we must be prepared,” Ding Yanqing called, ” At least one province must have a Class III biosafety protection (BSL -3) Autopsy Laboratory. “

This article comes from WeChat public number: China News Weekly (ID: chinanewsweekly) , author: Liming Zi