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"This is also the most interesting part of the rheumatology department. A patient who is difficult to treat, after analyzing the cause and pathophysiological process clearly, the diagnosis and treatment will be successful, and there will be a special sense of achievement. ”
Written by | Wan Shunshun
Source | "Medical Rheumatic Immunization Channel" public number
The Department of Rheumatology and Immunology of Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology (hereinafter referred to as "Wuhan Tongji Hospital") is the rheumatic immunology department with the strongest technical force, the most complete medical equipment and the most advanced level of diagnosis and treatment in Hubei Province, which has been ranked first in Hubei Province for many years, ranked 11th in the country in 2019, and ranked 13th in 2020.
In 2012, at the age of 38, Dong Lingli became the third director of the ace department and the youngest of all clinical departments in the hospital. Now, Professor Dong Lingli has become a professional leader in rheumatism in Hubei.
During her tenure as the director of the Department of Rheumatology and Immunology, Dong Lingli has held many academic positions, including a member of the Rheumatology Branch of the Chinese Medical Association, a member of the Rheumatology and Immunology Physicians Branch of the Chinese Medical Doctor Association, a chairman of the Rheumatology Branch of the Hubei Medical Association, a member of the Quality Control Center of the Department of Rheumatology and Immunology of Hubei Province, and a chairman of the Rheumatology and Immunology Branch of the Hubei Medical Biological Immunology Society.
From the initial exposure to IgG4-related diseases (IgG4-RD) in foreign countries, to the creation of ELISA (Enzyme Linked Immunosorbent Assay) to detect serum IgG4 level technology, becoming the discipline leader of rheumatology in Wuhan Tongji Hospital, Dong Lingli has worked hard in the field of rheumatism for more than 20 years, and can more and more appreciate the joy of rheumatology.
Professor Lingli Dong
Study abroad for cutting-edge progress in the field of rheumatism
IgG4-related disease is a newly defined immune-mediated chronic inflammation with fibrosis in the early 20th century, the main histopathology is lymphatic and plasma cell infiltration dominated by IgG4+ plasma cells, accompanied by striatine fibrosis, obliterated phlebitis and eosinophil infiltration.
During her study abroad, Dong Lingli participated in the discovery of IgG4-related diseases. Led by Professor Hisahiro Umehara of Kinzawa Medical University in Japan, they found that the serum IgG4 levels in many patients with Mikulitz disease were significantly elevated, and there was IgG4-positive plasma cell infiltration in the affected tissue. They were the first to isolate Mikuliz disease from the subtype of Sjogren syndrome and include it in IgG4-associated lymphoproliferative diseases. In 2009, the article was published in Annals of the Rheumatic Diseases, a top international journal in the field of rheumatism, with Lingli Dong being the co-first author.
After returning to Wuhan Tongji Hospital, Dong Lingli met a special patient. He was suspected of filariasis, accompanied by severe rubber legs and swollen scrotum. The Department of Hematology invited the Department of Rheumatology and Immunology to consult jointly, and based on past experience, Dong Lingli suspected that the patient was an IgG4-related disease. At that time, there was no way to detect IgG4 levels in China, Dong Lingli sent the patient's blood samples to Japan for testing, and asked the pathology department to do immunohistochemical staining, both of which supported Dong Lingli's suspicion that it was indeed IgG4-related diseases.
"The effect of hormone therapy was particularly good. After having a case, we slowly opened up the road of diagnosis and treatment and found the direction. Taking the patient's blood as a positive control specimen, Dong Lingli and her team were the first to establish an ELISA detection system in China, laying the foundation for the diagnosis of IgG4-related diseases.
In order to fill the gap in the field of rheumatic immunity of IgG4-related diseases, the monograph "IgG4-related Diseases" edited by Dong Lingli was published in 2015, which is the first book in China to introduce IgG4-related diseases.
On February 24, 2019, the Department of Rheumatology and Immunology of Wuhan Tongji Hospital hosted the first International Summit Forum on IgG4-related Diseases in China/ Photo courtesy of respondents
Patients with IgG4-related diseases are susceptible to multi-organ involvement, and the consultation process tends to be more deliberate, with most of the first visits to the department with organ involvement. Dong Lingli's team statistics found that more than 90% of patients are first diagnosed in other departments, such as otolaryngology and gastroenterology, respiratory or hematology.
"Although the First Catalogue of Rare Diseases, issued in 2018, defines IgG4-related diseases as rare diseases, as the understanding of this disease becomes deeper and deeper, more and more patients are slowly being patiented. At present, patients with IgG4-related diseases have always been available in our wards. Dong Lingli said.
Cultivate intensively and find fun in the treatment of difficult and complicated diseases
Dong Lingli often educates young people in the department to have "three hearts". Not the "three hearts" of "half-heartedness", but carefulness, patience and intention.
Because the diagnosis and treatment of rheumatism is more complicated, Dong Lingli said that rheumatic immune diseases often require doctors to observe the condition in more detail, patiently explain to patients, carefully diagnose and treat, and consult literature when encountering difficult patients.
When going out of the clinic, patients often take a thick medical record to seek medical treatment, and Dong Lingli will slow down and carefully read them one by one.
As the top department in the field of rheumatism in Hubei Province, the Department of Rheumatology and Immunology of Wuhan Tongji Hospital reflects the level of treatment of difficult and complicated diseases in the field of rheumatism in Hubei to some extent. Many difficult diseases in the province will be referred to Wuhan Tongji Hospital for treatment.
"This is also the most interesting part of the rheumatology department. A patient who is difficult to treat, after analyzing the cause and pathophysiological process clearly, the diagnosis and treatment will be successful, and there will be a special sense of achievement. Dong Lingli said.
In June 2020, a patient referred from the ICU ward in Enshi City impressed Dong Lingli. She has a 5-year history of systemic lupus erythematosus (SLE) and has not been regularly medicated for nearly a year. When he turned around, he was in a critical condition, and due to multi-organ damage such as pleural effusion, peritoneal effusion, necrotizing pancreatitis, periphery abscess and peripatic abscess, 10 tubes were inserted into the body: chest and abdominal cavity on both sides, peritoneal drainage catheters, and the patient also had continuous drainage of periphery and peripheryal catheters.
The patient was diagnosed with SLE and multi-organ failure, and the Department of Rheumatology and Immunology of Wuhan Tongji Hospital, together with the Department of Radiology, Biliary and Pancreatic Surgery, The Department of Gastroenterology, and the Department of Infection, conducted multidisciplinary consultations to discuss the most appropriate treatment plan and surgical timing, and after multidisciplinary cooperation, the necrotic tissue around the patient's pancreas was smoothly removed.
"In more than three months of treatment, we had to pull out the tubes on her body one by one. Now she has returned to normal life and work. Dong Lingli said that the patient who was pulled from the death line was "a representative of our Tongji's difficult and serious treatment." ”
During the pandemic,
Telephone follow-up of 15,000 patients with rheumatism
"Poor reason, same boat" is the motto of Tongji Hospital.
At the beginning of 2020, the new crown epidemic swept through Wuhan, as the chairman of the Rheumatology Branch of the Hubei Medical Association and the director of the Quality Control Center of the Department of Rheumatology and Immunology of Hubei Province, Dong Lingli thought: What can I do for rheumatism patients who cannot go to the hospital in time?
Subsequently, she led the rheumatology and immunology team of Wuhan Tongji Hospital, together with experts in the province, to compile "What should I do during the novel coronavirus pneumonia epidemic?" ——To Hubei Rheumatism Patients" collection of popular science articles.
The series of popular science is divided into general recommendations, rheumatoid arthritis, ankylosing spondylitis, dermatomyositis and polymyositis, gouty arthritis, SLE, systemic vasculitis, systemic sclerosis, primary Sjogren syndrome, lgG4-related diseases, a total of 10 parts, more than 14,000 words.
"How to prevent epidemic infection after home isolation, how to observe the condition, what to do if there are signs of recurrence, life precautions, etc., we have made a detailed answer in Koppori." At that time, the number of clicks on the article was quite large, which helped many rheumatism patients who were isolated at home. Dong Lingli said.
Later, some rheumatism patients in Wuhan were diagnosed with the new crown, and they consulted with front-line rheumatologists. According to her, 13 doctors and 27 nurses in the Department of Rheumatology and Immunology have participated in this "war epidemic" without hesitation.
"Due to the immune dysfunction of rheumatism patients, most patients take immunosuppressive drugs for a long time, what is the situation of rheumatism patients with new crown? We have done a series of single-center and multi-center studies on the infection of rheumatism patients with new crown pneumonia in Wuhan City and Hubei Province, and have made a Voice of China. During the new crown period, Dong Lingli's team published a number of research papers in "The Lancet -Rheumatology" and ARD, including the world's first study to assess the risk of new crown pneumonia infection in patients with rheumatic diseases, and the results of this research were awarded the "Top Ten Anti-epidemic Research" at the 6th Medical Scientists Summit sponsored by the Chinese Medical Doctor Association and the Physician Daily. At the same meeting, Dong Lingli won the title of the first "Most Beautiful Rheumatology and Immunology Doctor".
Top 10 Anti-epidemic Research/Respondents in 2020
"We fought the battle in 2020. Doctors on the frontline of the fight against the epidemic are treating patients on the frontline, and doctors from the scientific research team are working around the clock in the rear, and follow-up telephone and questionnaire surveys of 15,000 patients with rheumatic diseases. At that time, the article was often changed until one or two o'clock in the morning, and the two teams cooperated with each other to communicate online. ”
In addition, the new crown designated treatment hospitals are mainly respiratory and infectious disease doctors, and a small number of hospitals do not have rheumatologists. Dong Lingli also organized experts in the province to compile the "Expert Recommendations for Follow-up and Infection Prevention and Treatment of Patients with Rheumatism in Hubei during the COVID-19 Epidemic Period", pointing out that "many rheumatism patients take glucocorticoids or nonsteroidal anti-inflammatory analgesics for a long time, which may cover up symptoms such as fever, and frontline medical personnel should be vigilant." ”
As an expert in the field of rheumatism treatment, Dong Lingli is very pragmatic about her work, and she never plans too much. "Do your best in everything and don't waste every day."
Speaking of young people in the department, she encouraged young doctors to balance clinical and scientific work. Actively accumulate experience in clinical work and practice basic skills. What really looks like a doctor's skills is outside of the clinical 8-hour work. "Clinical work is not only about prescribing and diagnosing, but more importantly, it is more important to explore problems, do research outside of clinical 8 hours of work, answer questions that need to be answered clinically, or lead to some in-depth mechanism research."
Dong Lingli said that the development of the department needs to fully mobilize the enthusiasm of young people, and everyone paddles to drive a big boat. It is hoped that the "medical education and research" of rheumatology and immunology can develop synergistically and do better and better. Eventually, every young person becomes an independent and high-level specialist.
bibliography:
Zhang Wen, Dong Lingli, Zhu Jian, etc. Chinese Expert Consensus on the Diagnosis and Treatment of IgG4-related Diseases[J] Chinese Journal of Internal Medicine, 2021, 60(3): 192-206. DOI: 10.3760/cma.j.cn112138-20200803-00726.
[2]. What should I do during the COVID-19 pandemic? ——To patients with rheumatism in Hubei Province
Source: Rheumatic Immunity Channel of the Medical Community
Editor-in-charge: Zheng Huaju
Proofreader: Zang Hengjia
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