dkrc Chapter 6: Defection?!
Chapter 6: Defection?!
Lin Hui is a five-year medical student. After June, he will be a fifth-year student and will take the postgraduate entrance examination. He is currently doing an internship.
During his preparation for graduate school, he chose to intern in orthopedics, intending to pursue graduate studies in orthopedics, and thus his basic theoretical knowledge was quite solid.
Dong Anhua: "What kind of diagnosis can we get?"
Lin Hui: "Left lower limb deformity."
Dong Anhua smiled and said, "You're a medical student, describe it more professionally."
Lin Hui: "Genus varus deformity of the knee."
"Anything else?" Dong Anhua asked again.
Lin Hui memorized the relevant information very accurately: "Narrow joint space...wear and tear on the cartilage, there should also be osteoarthritis."
What type of arthritis is it?
However, Lin Hui was just an intern after all. When Professor Dong pressed him for knowledge beyond the undergraduate textbook, he was speechless and stammered.
Lin Hui shook his head decisively: "Teacher Dong... no, I don't know."
Chen Zhuoan clearly remembered the original text from the textbook: Osteoarthritis (OA) is a chronic joint disease characterized by degenerative changes in articular cartilage and secondary bone hyperplasia.
The text then elaborates on several categories of knowledge, including etiology, classification, pathology, clinical manifestations, and treatment.
Indeed, undergraduate textbooks do not contain specific classifications of osteoarthritis; this is specialized content found only in orthopedic residency training textbooks, postgraduate textbooks, and monographs.
"Do any of you know?" Dong Anhua planned to quickly pass by the interns.
The Department of Orthopedics at Xiangya Hospital is a strong and popular discipline, and only those with excellent grades dare to aspire to study for a master's degree here.
Yuan Pingping is a girl, and she prefers to go to internal medicine. Although she is a graduate student who was recommended for admission, she doesn't know how to read the professional textbooks for orthopedics.
Luo Yunhua and Lin Hui have comparable knowledge systems.
So Dong Anhua set his sights on Chen Zhuoan.
He knew about this eight-year program student.
Chen Zhuoan was among the first batch of eight-year undergraduate, master's, and doctoral students at Xiangya Hospital. Dong Anhua then said, "Zhuoan, tell me about it."
"Classification of osteoarthritis".
Chen Zhuoan took the film, shook it as usual, and then pointed it at the long, oval incandescent light on the ceiling.
Chen Zhuoan calmly explained: "Secondary osteoarthritis of the left knee, traumatic osteoarthritis of the left knee."
"This is simple tibiofemoral osteoarthritis. There is no cartilage damage to the patellofemoral joint cartilage. It is mechanical osteoarthritis."
"KL classification, grade 2 mild, with obvious osteophytes and slightly narrowed joint space."
"From a structural phenotype perspective, it belongs to the hypertrophic type." Chen Zhuoan's reply was quite systematic and professional!
It was so professional that even Professor Dong Anhua was taken aback.
It wasn't that Chen Zhuoan's professional knowledge shocked Dong Anhua, but rather that Chen Zhuoan's current demeanor made Dong Anhua quite uncomfortable.
Dong Anhua looked at Zeng Tianfang: "See? This is someone who has read the book."
"Chen Zhuoan mentioned five classifications in total: primary and secondary, anatomical location, imaging, clinical phenotype, and structural phenotype."
After explaining to the other interns, Dong Anhua continued with very professional questions: "So what's your opinion on this classification? How should it be treated?"
Chen Zhuoan took the X-ray and scanned it carefully: "Grade IV varus deformity, normal knee distance is about 8cm, active knee distance is about 6cm, bending angle is 38°, which is a severe type."
"Surgical intervention is necessary. A high lateral tibial osteotomy will be performed to shift the patient's lower limb alignment inward and relieve pressure on the inner tibiofemoral joint."
"Cartilage damage can be repaired to a slight extent, but not completely; it only slows the progression of osteoarthritis."
Chen Zhuoan then put down the film: "Based on this situation, if we had come four or five years earlier, the cartilage might not have been damaged yet."
"Auntie, why didn't you come to visit a few years ago?"
When Chen Zhuoan asked the patient his usual question, he noticed someone tugged at his shoulder.
Chen Zhuoan turned his head to the side, as Associate Professor Zeng Tianfang winked at him, indicating that he had overstepped his bounds.
Now, it's Professor Dong's place to demonstrate his abilities.
This is 10 years, not a past life.
Chen Zhuoan is currently just a graduate student and intern, and he just passed the medical licensing exam!
After realizing the reality, Chen Zhuoan quickly picked up the film again and pretended to continue reading seriously.
Professional teaching answers are practically second nature to Chen Zhuoan.
In his past life, when he was working, experienced professors and chief physicians also came to him for further training.
Dong Anhua was slightly overweight but possessed a refined and scholarly air. He looked at Chen Zhuoan thoughtfully for a while, then suddenly put his hands on his chest and asked, "You understand him very well?"
He was quite surprised by Chen Zhuoan's answer.
Chen Zhuoan really didn't know how to pretend for the time being. Although he had a deep memory, he couldn't make a complete decision about his knowledge system.
I only remember what I should memorize in 10 and what I should learn and memorize in 11.
Chen Zhuoan answered frankly, "Teacher, I've read some books."
Teaching rounds can be conducted at a slower pace, so Dong Anhua wasn't in a hurry:
"Structural phenotypes are still in the exploratory stage in clinical practice. The hypertrophic type you mentioned is only a preliminary concept, and there is no unified consensus in the industry."
"Secondly, this is nuclear magnetic resonance typing."
Chen Zhuoan became very interested when he heard about the professional content.
The teacher is right. In 2020, Roemer et al. proposed the "Rapid Osteoarthritis Magnetic Resonance Score (ROAMES)".
This classification, based on MRI, divides knee osteoarthritis into five structural subtypes: inflammatory, subchondral bone, meniscus/cartilage, hypertrophic, and hypertrophic.
Twenty-two years later, the industry proposed molecular subtyping, such as "abnormal glycosaminoglycan metabolism type" and "inflammatory type". It wasn't until about 35 years ago that Chen Zhuoan and others reached a consensus on this molecular subtyping.
In 2010, after quickly extracting some papers, Chen Zhuoan accurately replied: "Teacher, the current semi-quantitative scoring tools such as WORMS and BLOKS are all for the early diagnosis of early osteoarthritis that cannot be detected by X-ray."
"By summarizing the semi-quantitative scoring types, we can cautiously categorize them as the 'fat type'."
"It is characterized by excessive osteophyte formation, but the cartilage damage is not severe, so it's just like being overweight."
"If the osteophyte formation is not severe, but the cartilage damage is serious, then the person will be thin, or it will be atrophied."
The terms "hypertrophic" and "atrophic" were formally proposed in 20, but some preliminary quantitative indicators were also available in 10.
If you want to delve deeper, Chen Zhuoan could write a few papers from this angle; it just takes some time.
However, Chen Zhuoan would rather spend his time on more meaningful scientific research.
Dong Anhua immediately touched his forehead and asked a pointed question: "So, you don't actually want to pursue a master's degree with me, and you want to go work for Director Lei instead?"
The crowd's eyes flickered, and their bodies began to sway from side to side.
Chen Zhuoan blinked, seemingly puzzled.
But soon, Chen Zhuoan grasped Dong Anhua's meaning.
The study of osteoarthritis falls under the specialization of joint surgery, and Director Lei is Professor Lei of joint surgery.
After thinking it through, Chen Zhuoan calmly said, "No, teacher, I just saw it when I was reading the literature, so I remembered it."
"I know more about our trauma orthopedics department."
Trauma orthopedics is Chen Zhuoan's foundation, and he is undoubtedly the most proficient and knowledgeable in it.