Preliminary diagnosis of mucinous secretion in the lungs of 3 cases

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 Preliminary diagnosis of mucinous secretion in the lungs of 3 cases


Liu Liangs team for pathological anatomy

Novel coronavirus pneumonia professor Liu Liang, led by Professor of forensic pathology at Tongji Medical College of Huazhong University of Science and Technology, completed the autopsy of the first case of new crown pneumonia death at 3:50 a.m. in February 16th.

As of February 25th, novel coronavirus pneumonia deaths were pathologically dissected by the team of experts, of which 9 were performed by the Liu Liang team, and 3 patients have completed the initial diagnosis of pathology. The results of the study were as follows: (1) the 11 cases of the new crown pneumonia death were pathologically dissected.

Liu Liang introduced that the novel coronavirus pneumonia has similar SARS and its own characteristics. From the current pathological results, some of the lungs of the dead can see mucinous secretions, which he thinks is the place to be vigilant in clinical treatment - in the treatment, if the mucinous components are not resolved, simply using oxygen may not achieve the purpose, sometimes it will have adverse effects. Positive pressure may push the mucus deeper and wider, which will aggravate the anoxia of patients.

Recently, Professor Liu Liang and Professor Wang Guoping, Dean of the Department of Pathology, Tongji School of basic medicine, Huazhong University of science and technology, were interviewed by the media. Next, the expert team will connect the preliminary results of pathological research with clinical experts.

Full protection is required before entering the operating room for autopsy

The minimum age of the donor is 52

Reporter: novel coronavirus pneumonia for the pathological anatomy of the work? How many autopsies have been completed? What about the donors?

Liu Liang: from the 16th to today, our team has dissected 9 cases in total, and the team in Shanghai has dissected 2 cases in Wuhan. The proportion of male and female remains donors is almost the same. They are older, 60, 70, and over 80 years old. The youngest is 52 years old.

Reporter: Generally speaking, how many cases of comprehensive analysis are needed to reach a more scientific conclusion?

Wang Guoping: from a scientific point of view, the more the better. At present, 11 cases have been dissected, which can explain the problem to a certain extent.

Reporter: will we tend to look for younger deaths?

Liu Liang: pathological research cases are more beneficial, different people have different personality problems, (pathological anatomy research) is to find common problems in personality problems.

We hope to see the characteristics of the virus in different age, gender and physical conditions. Which people are easy to get sick, which people are not easy to get sick, this must be done.

Reporter: where is the autopsy?

Liu Liang: the autopsy was done in the operating room of the hospital. After consultation with family members, the autopsy will be carried out 6-8 hours after the patients death, and some will be later. All the corpses after the autopsy were sent to the funeral parlor for cremation.

Reporter: before that, it took a lot of time to apply for research. Is the current research situation improved and what is the attitude of family members?

Liu Liang: at the beginning of autopsy, it really took a lot of energy to ask for policies, find hospitals and work with family members, so it is relatively difficult to start.

Through media publicity, the family members of the deceased also understood the significance of pathological anatomy. Some clinicians told me that the acceptance of the family members was better than before.

Now, many hospitals begin to tentatively follow this mode, and many hospitals are actively contacting to carry out this work. I think in the future, it will not only be the cooperation between Jinyintan and Tongji, but also more hospitals will join in.

Pathology researchers study samples

The dead man had mucinous secretions in his lungs

Reporter: at present, are there any cases that have completed pathological research? What did you find?

Liu Liang: the preliminary results of pathological diagnosis of 3 cases have come out. More in-depth examination, such as immunohistochemistry and special staining, is still being done.

From the current situation, there are still relatively important findings, but the conclusion needs to be further communicated with clinical experts to see whether these lesions are caused by clinical treatment or by the disease itself

Reporter: from the autopsy situation, in addition to the invasion of lungs, what other organs are affected by the new coronavirus?

Liu Liang: the novel coronavirus pneumonia is more than damaging the lung at present. It also includes the immune system and other organs of the body, and it also needs to exchange views with clinicians.

Reporter: novel coronavirus pneumonia was found by Zhong Nanshan, academician. The lung performance is not a serious fibrosis. There are some alveoli, inflammation is very serious, and there is a lot of mucus. What problems do these performances reflect? How do these findings contribute to clinical treatment?

Liu Liang: under the microscope, we did find some mucinous secretions on the lung section of the dead, which can remind the clinical treatment to be vigilant.

Lung is the place where oxygen and carbon dioxide exchange in human body. Its function depends on the unobstructed airway, and the function of alveoli is better. At present, the function of the alveoli may be damaged, the airway is blocked by mucus, and there will be hypoxia in clinic. Therefore, in order to improve the state of hypoxia and keep the airway unobstructed, it is necessary to dilute or dissolve the mucus. In fact, this kind of medicine has been used so far, but you can try again.

In clinical treatment, if the mucus component is not dissolved, it may not achieve the goal by simply using oxygen, sometimes it will have adverse effects. Positive pressure oxygen may push the mucus deeper and wider, which will aggravate the patients hypoxia. Clinically, we may also pay attention to this matter, but we think we still need to emphasize this issue.

Reporter: through pathological examination, we found the exact infection site and main target organs of the virus. Can we make clear the transmission mechanism of the new coronavirus?

Liu Liang: the route of transmission of the virus is not a pathological problem at present. We have also done nucleic acid tests for different organs and tissues in the previous autopsy cases, and some of them have been found. These problems need further analysis, because the results of different cases are different

Reporter: some scholars have previously proposed that myocarditis or heartbreak syndrome may break out in some severe patients. Through anatomy, does this possibility exist?

Liu Liang: the problem of myocarditis is still to be discussed. I think the possibility of heartbreak syndrome is relatively small.

Reporter: the novel coronavirus pneumonia and SARS have high homology. The body anatomy shows that the difference between the new lung and SARS is very large. Any difference?

Liu Liang: the novel coronavirus pneumonia is similar to that of SARS, but it also has its own characteristics. We will do some interpretation later.

Pictured here is novel coronavirus pneumonia, who is in the protective clothing. He participated in the first case of new crown pneumonia. Liu Liangs anatomy was the first time.

Lack of protective materials for anatomy team

Reporter: what are the difficulties in our work?

Liu Liang: its very important for autopsy personnel to do anatomical protection, which is equivalent to going to the place with the highest radiation concentration. So far, the protective materials are from other places. I hope more people will pay attention to our special forces.

Reporter: the industry calls on major central cities in China to build dissecting rooms that meet the class A infectious disease standard as soon as possible, and the rules and regulations for the control and prevention of severe infectious diseases should also be further improved. What do you think?

Wang Guoping: the outbreak of the new coronavirus suggests that we should pay attention to the establishment of infectious diseases, especially the standard dissection room for class A infectious diseases, which is what we need to learn from?

At present, the autopsy rooms of P2 and P3 that are in line with this negative pressure have been seen in Beijing Ditan hospital and Guangdong Province when SARS occurred, but almost none in other places. The problem of anatomic room should be put on the agenda. The failure of anatomic room will lead to the delay of anatomic work.

The first confirmed autopsy report of the dead body announced that the lesions were still focused on the lung

The first novel coronavirus pneumonia was novel coronavirus pneumonia. 12 days after the body dissection, the autopsy report was released. It was clearly stated that the new crown pneumonia lesion still focused on the lungs, and the evidence for other organ injuries was insufficient.