Zhang Zhe’s child is actually suffering from chronic osteomyelitis. Chronic osteomyelitis does not require pathological examination to confirm the diagnosis. The diagnosis can be made based on the medical history, physical examination and imaging examination.
However, any organs and tissues removed during surgery must undergo pathological examination. This is a medical routine.
Song Zimo took this opportunity to study the pathological manifestations of this rare focal chronic osteomyelitis, and to see whether the surgery had really completely removed the lesions.
To this end, Song Zimo asked the pathology department to help make dozens of pathological slices of the entire removed bone plug, so that the entire bone plug could be observed in detail.
The pathological sections are cut into concentric circles under a microscope under a low-power microscope. The center is necrotic bone, the surrounding necrotic bone is infected bone tissue, and the outermost circle is normal bone tissue.
Under high magnification, the field of view is like an abstract painting. A small amount of infiltrating lymphocytes can be seen in necrotic and infected bone tissue, while there are no lymphocytes in normal bone tissue.
Judging from these dozens of pathological slides, each one is similar to a sandwich structure. That is to say, Yang Ping made accurate judgments based on the patient's images and planned the diameter of the trephine used in the operation. It was in place at one time during the operation.
Remove the entire problematic bone tissue.
Even if a surgical robot is used to do it, it cannot be so accurate because the surgical robot cannot replace the clinical judgment of the surgeon before surgery. It is just a passive tool.
Song Zimo, Xu Zhiliang and Gao Qiao, the three of them gathered around the multi-head microscope at the same time and continued to look.
For this kind of viewing of pathological slides, Yang Ping has received devilish training in the auxiliary examination training in the system space. Not to mention the viewing of pathological slides, he has personally done every process of the entire pathological slide production and is very skilled.
Now he just wants to pass on some experience to Song Zimo and Xu Zhiliang, so that they can also master how to read pathological slides. He hopes that one day, they can be more powerful than pathologists.
Xu Zhiliang did not have as much exposure to pathological slides as Song Zimo. When he was a PhD student, he did experiments and saw some, but had almost no contact after clinical practice.
Takahashi received systematic and standardized professional training in pathology, but after engaging in trauma surgery, he did not have much exposure.
Song Zimo received a call from Tang Fei. She and Fujiwara Miyuki had arrived at the door of the pathology department. They also wanted to come in and have a look.
Fujiwara Miyuki has been getting along very well with Tang Fei during this period, and she also wants to follow Yang Ping and be exposed to more cutting-edge technologies.
Song Zimo went out and brought the two people in. They sat quietly next to them. Fujiwara Miyuki greeted Yang Ping, and Yang Ping smiled in response.
The examination room was quiet, and the doctors at their workstations were all carefully reading the pathology slides. Occasionally, some people went out to use the bathroom, almost trotting out, then trotting in. After entering, they did not rest and continued to sit at their workstations to read the pathology slides. p>
If the daily tasks cannot be completed, they will be piled up until the next day, and a lot of specimens will be received the next day. This accumulation will only increase the number, and it is difficult to recruit pathologists, which are generally preferred by medical students.
In clinical practice, few people are willing to study pathology.
Therefore, pathology departments in large hospitals are not as competitive as clinical departments. To the extent that only those with Ph.D. degrees are not allowed to knock on the door. Even master's degree students in pathology departments have a chance to come in.
A young doctor suddenly stood up: "Have you seen Director Guan and Director Shi?"
"You should be looking at the frozen sections next door. Several specimens have just been sent for freezing." Another doctor replied.
"This child's, please help me take a look. There should be nothing wrong with it." The young doctor asked another doctor with more seniority to help.
The senior doctor went over to help look at it for a while: "This seems to be nothing, and I can't tell. Let's wait until the two directors come over to talk about it."
Yang Ping was resting next to him. Hearing the doctor's confusion, he simply gave him technical help: "Shall I take a look at it for you?"
The senior doctor raised his head and looked at Yang Ping, doubtful: "How about you help me take a look?"
I'm just curious, does this doctor of orthopedics really know how to read pathological slides? Or are they pathological slides of the gastrointestinal tract? I don't have any hope as to whether he can really read them.
The senior doctor gave up his seat, and Yang Ping sat down and looked for a while: "Lymphocyte infiltration can be seen in the esophageal squamous epithelium, which is probably Crohn's disease. Are there any slices from other parts? If gastroscopy and colonoscopy biopsies also show similar results,
Changes can be diagnosed as Crohn's disease."
The pathologists who were concentrating on their work all raised their heads, and Song Zimo, Xu Zhiliang, Gao Qiao, Tang Fei and Fujiwara Miyuki also looked towards Yang Ping.
"Look what I'm doing, that's it. Lymphocyte infiltration in the esophageal squamous epithelium is a mild manifestation of Crohn's disease in the esophageal mucosa. Are there also slices of other parts of the digestive tract? How about I help you take a look?
?" Yang Ping didn't expect that he would attract so many eyes when he opened his mouth.
A doctor of orthopedics is sitting in the microscopy room of the pathology department, instructing other pathologists to read the slides. The senior doctor just now must have ten years of experience. It is strange that people are not surprised.
The senior doctor was stunned for a while, then picked out two slides from a large slide box and handed them to Yang Ping.
Yang Ping put the slides under the microscope one by one. After reading it, he said: "Focus-enhanced gastritis in the gastric mucosa and focal active inflammation in the mucosa of the terminal ileum. There is no doubt. The diagnosis is Crohn's disease."<
/p>
At this time, Director Guan and Director Shi came in. The young doctor explained his confusion to the two directors. After all, Director Shi had rich experience. Every time he encountered a difficult problem, he still asked him to help.
"How about you take a break, Teacher Shi." Director Guan couldn't bear it. Director Shi just looked at several frozen slices and his eyes were red.
"It's okay, let me take a look." Director Shi was very persistent.
The old director sat down and read the three slides carefully before speaking: "Lymphocyte infiltration can be seen in the esophageal squamous epithelium, focally enhanced gastritis in the gastric mucosa, focal active inflammation in the terminal ileum mucosa, Crohn's disease!" The old director raised his head, took out his sunglasses and put them on: "The pathological changes in this case are very slight and cannot be seen by ordinary people. This was what my teacher taught me when I was a visiting scholar in the United States. Take note of this set of slides and arrange a small visit.
Let me tell you a lesson."
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The pathologist immediately looked at Yang Ping again, this time with admiration. He only looked at one slide, and then inferred the pathological manifestations of the other two slides and gave the most likely diagnosis. After reading
The other two slides were processed directly to confirm the diagnosis, and it only took less than two minutes.
As a pathologist, I am dissatisfied with this ability to capture images under the microscope.
An orthopedic surgeon is actually better at looking at pathological slides than a pathologist. What he is looking at is a slide from the Department of Gastroenterology, which is not enough to keep people alive.
Song Zimo was also surprised. If he hadn't dragged him down to see the pathology slides together today, how would he have known that this guy was so good at reading pathology slides? He was so versatile!
"Dr. Yang from the orthopedics department just looked at it and said it was Crohn's disease. I still don't believe it," said the senior doctor.
"Oh?"
Director Shi was greatly surprised. He stood up, picked two more slides from the box, and put one under the microscope: "Dr. Yang, can you help me take a look?"
Watch? Or not?
Yang Ping was not polite either. No matter if he really wanted to ask for help or to test himself, he couldn't refuse. He just took a second look and said: "Intestinal serrated adenoma (SSP)!"
Director Shi immediately changed a piece and showed it to Yang Ping, who quickly revealed the diagnosis: "Pan's cell metaplasia."
"The quality of the glass slide is not good. You can only see a cross section. It would be great if you could see the full-thickness structure of the flattened mucosa." Yang Ping added.
Director Shi took off his sunglasses: "Young man, it would be a waste not to engage in pathology. From a cross section, we can see intestinal serrated adenoma (SSP) and Paneth cell metaplasia. The national pathologist's wrench index. Indeed, this slide's
The quality is not good. If you use a high-quality endoscopic biopsy specimen, you can see the entire mucosal layer spread out, but we often cannot do that. Intestinal serrated adenoma and Paneth cell metaplasia are determined by observing the crypt base. Only
Only a full-thickness flat mucosa can reveal the crypt base. Changes in the crypt base cannot be observed, so ordinary doctors cannot make a diagnosis."
Director Shi turned to all the pathologists and said: "The quality of pathological slides has a very important impact on pathological diagnosis. To make a satisfactory slide, every step of collecting, embedding, slicing, staining and sealing must be taken into account."
They all have very high requirements."
“When I was a visiting scholar at the Department of Pathology at MIT, their endoscopic biopsy specimens could see the flattened full-thickness structure of the mucosa. In comparison, our domestic endoscopic biopsy specimens often only see a horizontal
Cut."
"This suddenly made me understand why we rarely diagnose colonic serrated adenoma (SSP) and rarely see Paneth cell metaplasia, which is more important in the diagnosis of inflammatory bowel disease. It is not a problem of the disease spectrum, but the slide.
It’s a question of quality.”
"Of course, there are problems with machinery and equipment, but it is more a matter of professionalism and professional ability."
"A perfect slice is very important. Not only is it pleasing to the eye, but the pathological changes can also be seen at a glance, ensuring the quality of pathological diagnosis to the greatest extent."
"Young man, what do you think is the problem with these slides and what needs to be improved?" Director Shi asked Yang Ping. He wanted to see how much this young man understood.
Yang Ping could only point out objectively: "During the production process of this specimen, it was curled when dehydrated, the tissue was not raised up when embedded, the color matching of HE staining was not very coordinated, and there were holes and glue overflow in the sealing. If these steps could be improved,
It should be better after a while."
Director Shi almost applauded: "It's very well said. For example, all the colors of HE staining are perfectly coordinated. Intraepithelial lymphocyte infiltration can be accurately detected under low magnification, and will not be invisible under high magnification; including
When burying, stand the tissues upright, and all the tissues will be arranged neatly like soldiers in formation, which can ensure that the full-thickness structure of the mucosa can be cut out during sectioning."
"Young man, have you ever done pathology before?" Director Shi was curious about how he knew so much knowledge.
Yang Ping doesn’t mean to show off, he just wants to share the knowledge he has with everyone so that everyone can improve and do better next time. The biggest headache is explaining: “When I was studying, I was more interested in pathology.
So I studied very seriously."
Not only can I read pathological slides, but I am also so familiar with the process of making pathological slides. I can tell at a glance where the shortcomings of a slide are and where the problem is. It is no longer as simple as interest.
If the IQ is calculated based on a full score of 200 points, Takahashi originally estimated that Dr. Yang's IQ would start at 160. Now I feel that Dr. Yang's IQ is about to break through the 200-point mark. He has received professional and systematic pathology training, which is the highest level.
Not worthy of Yang Ping’s occasional interest.
Seeing Yang Ping sitting there, calm and calm, Miyuki Fujiwara didn't know why, but she suddenly had an inexplicable intuition that there was loneliness hidden in Yang Ping.
Perhaps, that’s because the height of genius is so cold.
