Chen Jingyu, vice president of the People's Hospital of Wuxi City, Jiangsu Province, a member of the International Heart and Lung Transplantation Society, a member of the Chinese Organ Transplantation Society, and a director and professor of the Lung Transplantation Center of Jiangsu Province enjoy special allowances from the State Council. Has long been engaged in general thoracic surgery clinical work, in recent years began to engage in basic and clinical research of lung transplantation.

Reporter: You led the team to insert the red flag in the clinical peak of domestic thoracic surgery. Can you talk about the development trend of general thoracic surgery?

Chen Jingyu: Lung transplantation is the most difficult and technically demanding item in organ transplantation. Since Professor Xin Yuling launched the first lung transplant in China in the 1970s, China's lung transplant work has been stagnant. By 1998, there were less than 20 lung transplants in the country and only 2 patients survived long-term. In 2002, as a training target for the health system in Wuxi City, I was sent to the International School of Lung Transplantation, the leading university of the international lung transplantation technology. After returning to the country the following year, I succeeded in carrying out a large number of animal experiments and finally succeeded on September 28 of that year. The first lung transplant in Wuxi was implemented. At that time, I led a single-lung transplant to a patient with an average age of 33 years old who had undergone single-lung transplantation for patients with emphysema, lung damage, and severe respiratory failure. This was also the first case of lung transplantation in China to treat chronic obstructive disease. Emphysema. At the time, clinical lung transplantation in China had been quiet for 5 years. I have been studying this project in the People's Hospital of Wuxi. As of the end of September this year, our hospital has successfully carried out more than 160 cases of lung transplantation, accounting for more than 1/2 of the same kind of surgery in the country. Among them, there were 101 cases of single lung transplantation and 60 cases of double lung transplantation. At present, there are two aspects of the development of surgery: First, the more detailed, smaller and smaller, minimally invasive surgery; the other is bigger and bigger, to the direction of transplantation, Thoracoscopic surgery and lung transplantation technology Will become a development trend.

Reporter: Your lung transplantation project won the second prize of the Chinese Medical Association Science and Technology Award. What are the main reasons why your hospital has been respected by domestic and foreign counterparts?

Chen Jingyu: Compared with our foreign counterparts, the number of lung transplants we perform is not large, but it is respected by our peers. The important reason is that we have an elite team and we have established a nation’s first lung transplant department independently from the thoracic surgery. Hospital resources collaborate. The other is the amount of surgery, and now the country can do less than 10 cases, the other major hospitals do up to 35 cases, as we do not do routine surgery. In June 2010, the Ministry of Health Human Organ Transplantation Data Center Work Conference established the statistics center for the transplantation of the four major organs of heart, lung, liver and kidney of the Ministry of Health. At that time, the People’s Hospital of Wuxi, the People’s Liberation Army 309 Hospital, Beijing Fuwai Hospital and Hong Kong Maria Hospital and other top 3 domestic hospitals are on the list.

Reporter: What is the key direction of technical attack in your hospital?

Chen Jingyu: Currently, the main technical barriers restricting the development of heart-lung transplantation are the shortage of donors, high mortality rate of recipients, early postoperative lung graft failure, and chronic rejection, leading to low long-term survival rate. This is also the focus of international research on lung transplantation. . In addition, the gradual increase in donors for brain death donations will also bring new challenges to the development of lung transplantation in China. Most patients with brain death undergo rescue measures such as endotracheal intubation and multiple drug use. The lungs of donors will have varying degrees of damage in the process. Whether these injured lungs are suitable for lung transplantation and whether they can be repaired are all needed. Solve the problem, therefore, the next step related parties will formulate lung assessment criteria as soon as possible in light of national conditions. There are tens of millions of patients who only have emphysema in the country. There are also many patients who need to change their lungs. We must study hard for lung repair techniques to increase the lung source.

Reporter: Under your leadership, a large number of technical backbones have been trained. How do you plan and coordinate the hospital resources?

Chen Jingyu: From a policy perspective, the “separation of management from management” pilot has accelerated the process of cultivating high-end talents in Wuxi City. At that time, I went out to study and I was also one of the high-level talents training programs in Wuxi. The attention and support of the leaders of the hospital is also very important. In 2002, my first operation caused my hospital's high attention to lung transplantation. I feel that this project has been greatly developed, and it gave a better environment, including the resources of the entire hospital, including various disciplines, departments, and even logistics. I did a very clear flowchart of patient treatment in the Lung Transplantation Department. In the flow chart, each staff member has a clear division of labor and responsibilities, like a highly efficient engine, ensuring that each Lung transplantation was successful. At present, there are about forty to fifty people in the core team, including the team whose preoperative patients come for maintenance, donor acquisition for surgery, surgical anesthesia and postoperative management. The most recent postoperative management team, including ICU doctor care. As a key discipline in Jiangsu Province, it is an important task for me to actively build a learning and research lung transplant team.

There is no development without connection. Reporter: In your opinion, what is the biggest difference between the current field of lung transplantation in China and foreign countries?

Chen Jingyu: Lung transplantation has entered a stage of slow development. It used to be the organ of the death penalty. Now, the donor is a major bottleneck. I think the main difference between China and the international community is that it is not connected. How to connect? It is necessary to communicate and communicate with the international advanced concepts and technologies for lung transplantation. The international community is still very repellent to our lung transplantation. The reason is that from a humanistic perspective, the source of lung transplant donors in China is still not recognized. Not long ago, I wrote an article intended to be published in this year's Global Heart-Lung Lung Transplant Society Annual Conference, International Cardiopulmonary News, and I was rejected. Later I wrote to the chairman of the conference and mentioned that lung transplantation in China is the same as in the world. Now, he has begun to successfully use brain death and cardiac death donation to the lungs. Later, the chairman of the conference was very interested in the article. He also supported me to write about the use of brain-dead and heart-dead lungs for lung transplantation in mainland China. The article made a brief introduction, which shows that the international community does not understand the Chinese lung transplantation.

In addition, the concept is also very important. Some people are afraid of lung transplants. They feel that this is an immature technique. They are risky. Unless the patient relies on the ventilator, they will only seek help with lung transplantation. This will make the surgery more difficult, the risk more serious and the mortality rate higher. There is a saying that overseas lung transplantation is to improve the quality of life, and the current situation in China is to save lives. This is the difference in understanding. Most lung transplants in our country are similar to emergency lifesaving surgery, affecting the overall success rate. Therefore, I often invite physicians in the hospital's respiratory department to observe lung transplants and let them know that lung transplantation is a routine operation. At present, the total number of liver transplants in China is 1,500 per year, and about 3,000 kidney transplants are used. Lung transplantation uses only about 2% of its lung supply. The potential number of lung transplant patients is estimated to be 10,000 to 20,000. Therefore, the biggest reason behind the delay in the development of lung transplantation in China is not the lack of lung resources and technology, but because of lack of understanding of lung transplantation.

In the past, I did not pay attention to propaganda. Now I want to open microblogging to make popular education from the professional perspective to the public, and even live lung transplants on Weibo. Such as the Beijing girl Huanhuan (a pseudonym), I was the first one to give her a live surgery, originally did not want to live, there are some pressure, but then I think or decided to broadcast. Of course, when the patient sees me on the live broadcast, my heart is more practical, because the live broadcast will certainly be more cautious. My idea is to let everyone see that lung transplant surgery is mature.

Reporter: Your hospital is a benchmark hospital for lung transplantation in China, but you also admitted that basic research is the same short board that your institution is facing. How do you respond?

Chen Jingyu: Indeed, at present, the lung transplantation itself has done relatively little in the country. Unlike liver-kidney transplantation, which is very common, the hospital is not interested in conducting basic research. This is the relatively least place in China. For example, the academic environment and geographical environment of our center have determined that it is not a basic research center. Therefore, we go backwards, first make the clinical work well, and then go back and do basic research. Now we have obtained the title of Key Laboratory of Lung Transplantation of Science and Technology Department of Jiangsu Province, and established a large animal and small animal laboratory. This basic research is carried out by dedicated researchers. The core team takes the model of establishing pigs and rats and other animals. It is standardized and procedurally used. The basic research will be furthered through the use of gangs.

For this reason, there are several directions to be noticed: First, the heart and brain for the death of the lung, to expand the source of the donor, in this regard for some basic research; Second, the injured lung in vitro perfusion repair, which is currently more advanced internationally Technology, China has not yet started. On the 24th of this month, the National Continuing Education Program hosted by our institute and the 6th National High-level Symposium on Heart and Lung Transplantation will be held in Wuxi. I have specially invited famous international heart and lung transplantation experts and Professor Shaf Keshavjee of the General Hospital of Toronto to give a special lecture. We have conducted extensive and in-depth exchanges on the clinical, basic and basic aspects of cardiopulmonary transplantation, including advances in clinical and basic medicine such as transplant infection, transplantation immunity, artificial heart-lung technology, transplant care, and minimally invasive chest techniques.

Reporter: Not long ago, the Ministry of Health announced that it would implement a unified national distribution system for transplant organs. What impact will this have on the future of organ transplantation in China?

Chen Jingyu: Heart Death Organ Donation (DCD) is the future direction of organ transplantation in China, and is also a sign of the improvement of national civilization. Last year, our lung transplant team took the lead in carrying out a "heart donor organ donation" lung transplant. So far, 4 cases of DCD lung transplantation have been carried out, including 2 cases of double lung and 2 cases of single lung. We have not only carried out lung transplants in Wuxi, but also visited more than 20 triple-A hospitals in nine provinces (cities) including Beijing, Guangzhou, Nanjing, Hangzhou and Wuhan to help develop lung transplantation. However, in this process, even in fairly limited donor resources, there is still a considerable amount of waste. Encourage the public to donate organs and distribute them in an open, fair and impartial manner, and prevent private transactions and rights trading. This is also a very wise step toward international standards. Previously there have been cases where after the organs such as the liver were used, the lungs had not found the receptors and was finally wasted. Uniform distribution across the country will ensure the maximum utilization of each donor’s organs, and will be distributed rationally through national transplant centers, eliminating subjective and human-induced interventions. The principle of distribution is based on whether the blood type, age, and tissue matching of the two sides are consistent with each other, but also depends on the urgency of the patient's condition. In short, this is a very good policy.

Reporter: You usually take into account the task of teaching. Do you think there is a need for docking in modern medical education?

Chen Jingyu: This is a relatively high-end subject. In the ordinary course of teaching, I think students should be as knowledgeable as possible, diligent in learning, and dedicated. Between teaching and clinical, I think the education of the school is rather rigid and it is necessary to inspire their thinking as much as possible and cultivate their rigorous thinking patterns. Studying heart and lung transplants requires very lively thinking to inspire students. The next step is to use this mode of thinking flexibly to solve problems, but also to cultivate students' abilities. There is a lot of integration in medicine. For example, a surgeon needs to be a doctor with a very good foundation of internal medicine, so that you are a competent surgeon. Physicians do not have a little surgical foundation and they are very integrated. Such a model is also most beneficial to patients.

The hospital reform saw reporters in this way: Since 2001, Wuxi has begun trial implementation of the trusteeship system to achieve a proper separation of ownership and management rights. How do you see the reform of public hospitals today?

Chen Jingyu: Since 2001, he has tried the custodian system in 9 municipal hospitals. Wuxi’s exploration has been at the forefront of the reform of public hospitals nationwide. I remember when I participated in the National "Two Conferences" in 2007, the state leaders talked about the eight-character principle of the medical reform. But now, when we look back, we have seen no major changes in the reform of public hospitals everywhere. In September 2005, Wuxi Municipality divided the Health Bureau into two. The Medical Management Center represented the government to exercise the responsibilities of the investor in more than 10 units including 9 municipal hospitals, 1 health school, etc., ie to assume the functions of government-run hospitals. . The Municipal Health Bureau spared no effort to focus on the city’s health development plan and public health, conduct business guidance and industry supervision on the hospital, and act as a “management hospital”.

In accordance with the system design of “separation of management and management”, the right to make decisions on people, finances, and objects in municipal hospitals belongs to the medical management center, and the medical management center has the responsibility and obligation of maintaining value and increasing efficiency for the assets of municipal hospitals, and carries out resources within the system. Deployment is also a matter of reform. The People's Hospital is the largest tertiary hospital in Wuxi. The state has invested about 2 billion yuan in the reconstruction of hardware and software. Our goal is to become an advanced hospital in the province within five years and become a nationally renowned hospital. The system design of “Separation of Management and Management” is conducive to the introduction and training of key talents, technical backbones, and cooperation with the community.

Reporter: What do you think is the difficulty in the reform of public hospitals?

Chen Jingyu: From Wuxi's perspective, I think the current Wuxi model has an urgent task to link the reform of large hospitals with community medical institutions because the medical center is only a pilot municipal hospital, and the community is Wuxi Health Bureau. Pipes, divided into two mouths and then managed, many places are easily out of touch. Now we are the opposite of foreign countries. Patients from foreign countries come first to the community. If they fail, they go to the hospital. The outpatient clinics in China look at the diseases of the community. Large hospitals and communities have to implement integrated management.

There is a key issue here. Realizing the docking of large hospitals and communities requires the government to carry out reforms. Under the “separate management and management system” system, the medical management center managed the coordinated development of hospitals to avoid the vicious competition of hospitals in the city. The integration of medical resources is conducive to the development of key disciplines. This is the most successful place for the Wuxi model, under such a model. Major disciplines such as lung transplantation were developed.

Reporter: The last question, as you can see from your Weibo, is that you are willing to share the academic leaders. This is a necessary condition for academics. Regardless of whether it is a carved chapter or a cat, it can be seen that you will adjust your mood while you work. Now that the pressure on medical workers is too great, can you share the pressure relief?

Chen Jingyu: Nothing special, but it is suggested that medical workers must cultivate other interests and hobbies. Exercise is also very important. Playing table tennis, badminton, and running are good decompression methods.