If you put aside the introduction, respiratory diseases can be said to be the first chapter of the textbook "Internal Medicine", which is enough to see the importance of breathing to life. It is not only because from the first cry of the baby when it is born, to the last sigh of the old man when he is dying, it is all under the control of one breath and one breath. More importantly, as a serious threat to human health, respiratory diseases still have many questions to be explored and answered clinically. For example, the pathogenesis of asthma, COPD and bronchiectasis, the differential diagnosis of community-acquired pneumonia** and interstitial lung disease (ILD) ......Behind each disease, there are many clinicians, who are striving for the infinite approach of the diagnosis and treatment of respiratory diseases.
Department of Respiratory and Critical Care Medicine, East Hospital, Tongji UniversityofProfessor Zhu XiaopingIt is to devote himself to the exploration of ILD diagnosis and treatment options, and is committed to seeking suitable clinical solutions for ILD patients.
Spark: To do it, you have to challenge the biggest field
Talking about her initial impression of ILD, Zhu Xiaoping's memory was pulled back to the early 21s. As a platform for doctors to exchange medical information, disseminate new knowledge, and discuss difficult medical problems, academic conferences are an important part of promoting the improvement of doctors' skills. It was also in the process of participating in various academic conferences that Zhu Xiaoping paid attention to ILD.
Whether it is the American Chest Annual Meeting or the European Chest Annual Meeting, there are many people who choose to attend the lectures at the ILD venue. This made Zhu Xiaoping realize that ILD may be a difficult issue that needs to be paid attention to in clinical practice in the future. In order to better understand the disease, Zhu Xiaoping studied all the courses related to ILD.
As her studies progressed, Zhu Xiaoping's interest in this type of disease became stronger and stronger. Even when she returned to China, Zhu Xiaoping was looking for relevant courses and sharing on ILD in major academic conferences.
As a large group of respiratory diseases with unique characteristics, ILD currently includes more than 200 different types, among which the common ones are idiopathic pulmonary fibrosis (IPF), hypersensitivity pneumonitis (HP), connective tissue disease-associated ILD (CTD-ILD), and sarcoidosis. A growing body of studies has shown that there is significant heterogeneity among the various types of ILD in terms of pathology, clinical manifestations, methods, and prognosis [1]. This means that it has very high requirements for the comprehensive quality of clinicians and contains great challenges. The height of the world is always determined by those who bravely climb the peak, Zhu Xiaoping is the one who bravely climbs the peak, and the challenge brought by ILD did not discourage her, but gave her a courage to conquer the disease.
The real bond came 5 years ago, with the strong support of the leaders of Pudong New Area and Dongfang Hospital, Professor Li Qiang was introduced to our discipline as a discipline leader. Zhu Xiaoping introduced that after the arrival of Professor Li Qiang, the department has established a very excellent respiratory interventional diagnosis and treatment platform, which can use various interventional diagnostic techniques such as lung tissue or lymph node biopsy guided by endoscopic ultrasound, transbronchial frozen lung biopsy, etc. It is precisely because of the existence of this platform that it provides the possibility for a clear clinical diagnosis of interstitial lung disease, especially cryopulmonary biopsy, which can mostly replace surgical lung biopsy and significantly improve the probability of confirming ILD. Professor Li Qiang discovered Zhu's passion for this field and suggested that she focus on this subspecialty area.
In recent years, there has been great progress in the diagnosis and treatment of ILD. Zhu Xiaoping introduced that in addition to frozen lung biopsy, clinical attention to multidisciplinary diagnosis and treatment is increasing. Based on the heterogeneity and long-term clinical practice of ILD, many guidelines or expert consensus on the diagnosis and treatment of ILD diseases at home and abroad, such as the Diagnosis of Acute Exacerbation of Idiopathic Pulmonary Fibrosis and the Chinese Expert Consensus (2019) [2] and the Chinese Expert Consensus on the Diagnosis and Treatment of Pulmonary Sarcoidosis (2020) [3], all recommend organizing multidisciplinary discussions (MDD) and building a multidisciplinary diagnosis and treatment team (MDT) to improve the accuracy of ILD diagnosis and develop individualized plans.
Gathering firewood: Gathering multidisciplinary forces to build a platform
In the process of learning about ILD, Zhu Xiaoping also moved forward side by side with many disciplines, such as cooperating with pathology, laboratory and even microbiology teachers to seek specific ** for patients with pulmonary granulomatous lesions; He worked together with colleagues from the Department of Rheumatology and Immunology and the Department of Critical Care Medicine for the diagnosis and ......treatment of rapidly progressive interstitial pneumonia secondary to MDA5-positive myopathy dermatomyositis
On one occasion, we met a very young patient, who was only 30 years old, had been coughing up blood intermittently for a year, and had a mass of consolidation in his lungs, but unfortunately we never had a clear diagnosis of him. Zhu Xiaoping recalled, "At that time, we felt that this patient was relatively young and the diagnosis of lymphostic interstitial pneumonia by imaging was atypical, so we tended to consider that this patient might be lymphoma." In order to further clarify the diagnosis, Zhu Xiaoping and her team convened experts from the pathology department and imaging department in the hospital to jointly analyze the patient's imaging data and pathological sections, and finally confirmed that it was a secondary lymphocytic interstitial pneumonia. "This patient's story has made me deeply feel the importance of MDT. It was also at this time that a plan to form an MDT team for interstitial lung disease was brewing in Zhu Xiaoping's chest.
Pathology is the undisputed first choice of the MDT team for interstitial lung disease, but radiology, rheumatology, critical care medicine, and infectious diseases also play an important role in the diagnosis and treatment process. "MDT's cooperation is like-minded, and we look forward to becoming a top sub-specialty through cooperation with various top specialties. ”
As the core department in the diagnosis and treatment of ILD, especially the doctors in the ILD subspecialty in the department, the respiratory department has the most profound knowledge and understanding of the disease, the strongest ability to grasp the disease diagnosis and indications, and the largest weight in the construction of the MDT evaluation system. Zhu Xiaoping introduced that the daily work of each brother department is also busy, so this requires the respiratory department itself to improve its own diagnostic level, and can put forward relevant assessment content such as tendentious and clear pathological characteristics in the consultation process, so as to facilitate the development of diagnosis and treatment.
In this process, I hope that not only our respiratory doctors will build a lasting subspecialty. "In fact, I also hope that this will promote the establishment of pathology, imaging and even rheumatology, and establish a subspecialty direction for ILD, so as to effectively shorten the process of definitive diagnosis of ILD." ”
Perseverance: Do your best to meet the needs of patients
Among respiratory diseases, ILD is the most difficult to diagnose and treat; And in respiratory critical illness, the most difficult is ARDS. In most cases, there are ARDS-like manifestations in the process of acute severe ILD, and with the excellent respiratory intervention platform and RICU of the department itself, the MDT team formed by Zhu Xiaoping focused on the direction of acute severe ILD.
In addition to the excellent platform, we also have experienced respiratory interventional subspecialty talents in our team, as well as an excellent team of respiratory experts, which makes it possible for us to perform cryopulmonary biopsy with high diagnostic efficacy and safety for patients with pulmonary diffuse disease ILD with respiratory failure, and to make a definitive diagnosis. Although there will be some difficulties, I believe that with the blessing of our innate advantages, we will slowly overcome them. ”
With the accumulation of her career, Zhu Xiaoping realized the complexity of interstitial diseases and the limitations of diagnosis and treatment methods, such as the difficulty in diagnosis and treatment of severe ILD and the unsatisfactory results, but also felt that she should do her best to help patients solve problems. "We have to go all out to break through this limitation, which is not only a responsibility, but also the original intention we are chasing for doctors. "For example, to increase disease awareness and strive for rapid diagnosis, including rapidly progressive ILD; Continuously strive to explore the team's awareness of clinical imaging laboratory examinations and promote the development of high-quality MDT; Continuously improve the management level of chronic and subacute ILD; Reduce the patient's acute exacerbation and seek more appropriate treatment for acute exacerbations.
Under the leadership of Zhu Xiaoping, Dongfang Hospital's ability to diagnose and treat interstitial lung diseases has made rapid progress, and this year (2023) it has become the first batch of excellent units of the National Standardized Diagnosis and Treatment Center for Interstitial Lung Diseases. Referring to the future diagnosis and treatment development of ILD in Shanghai, Zhu Xiaoping said that it is necessary to lead the team to further carry out high-quality clinical research and strengthen the high-quality construction of MDT; Continuously strengthen exchanges with top interstitial disease diagnosis and treatment centers and strengthen international cooperation; Further improve the level of rapid diagnosis and treatment and whole-process management.
For patients, they are chasing the best of the disease, the best medicine, and the best means. As a doctor, it is necessary to meet the needs of patients through continuous learning of cutting-edge knowledge and progress, optimization of key technologies for diagnosis and treatment, which is the light in my heart and my pursuit. ”
References:
1] Yu Na, Wang Wei. **Progression of interstitial lung disease[J].Journal of Clinical Internal Medicine, 2022, 39(10): 656-658
2] Diagnosis of acute exacerbation of idiopathic pulmonary fibrosis and **Chinese expert consensus[J].Chinese Medical Journal, 2019(26): 2014-2023
3] Expert consensus on the diagnosis of pulmonary sarcoidosis in China[J].Chinese Journal of Tuberculosis and Respiration, 2019(09): 685-693
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