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Re: YJZ: 医网情深:5-22-2017病理实习笔记
[版面:医学职业][首篇作者:USMedEdu] , 2016年04月29日23:45:18 ,45076次阅读,352次回复
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USMedEdu
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发信人: USMedEdu (US_CMGs), 信区: MedicalCareer
标  题: Re: YJZ: 医网情深:5-22-2017病理实习笔记
发信站: BBS 未名空间站 (Fri Feb  9 00:42:17 2018, 美东)

医网情深:远方来信——相信我们还会相见

房军


何医生:

你好!
我是房军。看到你发布的募捐微信。特与你建立微信连接。你可以公开此信息。

我是她济宁医学院本科和北京大学医学部硕士同学,同学八年,但分别后十八年没见,
突闻噩耗,心情复杂。一来想了解下她去世具体时间,另外想问如何捐款。

她不是一个乐于享受成功的人,她更乐于享受奋斗,一生都在奋斗,当年我没能跟上她
的节奏,至一十八载杳无音。倒在奋斗的路上,对她来说,惋惜,悲壮,幸福!

这么多年,我并没有十分努力的打听她的消息。因为我相信我们还会再见,再见那天隔
的越久远,越温馨。我两次去美国,都努力在街头闲逛,心里实际期待十分渺茫的偶遇。

毕业二十年,同学们努力找寻,还是没有她的消息。我想,分别也许还不够久远。我独
自去了老校区的那些地方,有点担心,三十年时,这些地方是否还能寻见,但心里还是
充满再见的希望。

没想到,真的够久远!我已记不起上次分别的情形。再见真的够久远!再见在下个轮回。

算是一篇祭文吧。谢谢您,何医生!


3/7/2018
附:

A Time For Us

Andy Williams

LYRICS:

A time for us, someday there'll be
When chains are torn by courage born of a love that's free
A time when dreams, so long denied
Can flourish as we unveil the love we now must hide
A time for us at last to see
A life worthwhile for you and me
And with our love through tears and thorns
We will endure as we pass surely through every storm
A time for us, someday there'll be
A new world, a world of shining hope for you and me
A time for us at last to see
A life worthwhile for you and me
And with our love through tears and thorns
We will endure as we pass surely through every storm
A time for us, someday there'll be
A new world, a world of shining hope for you and me!


Songwriters: Edward Snyder / Lawrence Kusik / Nino Rota
A Time For Us lyrics © Sony/ATV Music Publishing LLC
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USMedEdu
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发信人: USMedEdu (US_CMGs), 信区: MedicalCareer
标  题: Re: YJZ: 医网情深:5-22-2017病理实习笔记
发信站: BBS 未名空间站 (Fri Feb  9 00:44:09 2018, 美东)

说明:我是CAHON的终身会员,但我以自己个人名义募捐,所得善款仍会交给CAHON指定
的朱新华医生汇聚一起交给家属。如果你决定经过CAHON(美国华人血液和肿瘤学会指
定的受款人捐款给Dr. Gao家属,则:From CAHON WeChat group: Please send your
personal voluntary donation check to @朱新华 with the instructions below: "
Mailing address: Xinhua Zhu, 249-19 Thornhill Avenue, Little Neck, NY 11362"
, with check payable to "Chuanshen Wu" (Limin's husband) and in memory of
Limin. Then @朱新华who serves as a CAHON representative to collect
individual personal donations from CAHON members, then give all together as
CAHON member donations to Limin's husband
and her family.

医网情深:为一位在胜利到来之际而倒下的中国医生募捐

力刀


Dr. Limin GAO走了——2017年,在她即将完成内科肿瘤专科医生培训、而且已经获得
MSKCC在新泽西州一个分支医疗单位录用之时,却发现患了癌症,经过一年的治疗,终
于还是走了——留下了年幼的孩子和彼此相爱、仍在做住院医生的夫君、带着深深的遗
憾——未能把所学专业用于治疗癌症患者,自己却倒下了!

令人心疼……

我只在2003年,我做住院医生第三年至2006年做骨/软组织肿瘤病理Fellow期间,为我
的家乡河南农村因卖血而感染HIV病毒/艾滋病农民的孤儿们做过募捐,为此,耗费大量
的精力和心血。此后,再未做过募捐活动。

看到这个令人痛心的消息,我决定将以我个人名义,把每年奖给一个经过我培训而成功
地进入住院医生、而且努力工作有所成就的住院/fellow的奖学金$500捐给她的家属,
尽管她与我素未平生,没有任何直接间接关系,只是因为她是一个在完成培训最后时刻
倒下的肿瘤内科fellow、中国医学生同学,我这十多年来做的最多的就是业余培训CMG
同学争取进入住院医生行列,希望看到我们美国华裔医生的队伍的壮大,而她却倒在即
将毕业的大门门栏上,让我心疼不已……

同时,我想以“老刀”自己的名义为她募捐——任何人,任何形式、任何数目的善款,
我都接受,并从心底感谢你们。老刀没有什么显赫的教授头衔、职务和学术地位,只有
一份诚挚的热情:在中文网上义务写了二十多年的医学科普、政论文章、10年里亲自义
务辅导过国内外上千的申请美国住院医生的中国医(学)生、建立了13个微信群与国内
外上万的医生们交流讲座、自2008年以来,奔波于北上广、以及河南和青海,进行交流
讲学。这些,是我的信誉所在,不是为了表功,而是坦荡地让你们看到我的为人,让你
相信你把善款交付委托的收款人的信誉。仅此而已。

记得我当年与四位笔友一起为河南艾滋孤儿募捐,她们四人一致举荐我来受款,而许多
捐款与我的朋友及素未平生的捐款人寄来支票甚至现金,连收据都不要。一位网友随支
票留言:“读了你10年来发在华夏文摘的文字,那些就是收据……”——让我感动落泪!

现在,我,老刀,再次进行募捐,为这位不幸病逝的中国医生——Dr. Limin Gao。

感谢你们的信任、支持和帮助!


2/6/2018 于美国纽约 刀客聊斋
美國病理會診中心:
网站:http://ampathology.com
电子邮件:service@ampathology.com
美中醫學教育網/網絡老刀會:
http://physicians.cmgforum.net
http://dok.cmgforum.net
微信號:dok2401

附:如果你决定经过CAHON(美国华人血液和肿瘤学会指定的受款人捐款给Dr. Gao家属
,则:From CAHONwechat group: Please send your personal voluntary donation
check to @朱新华 with the instructions below: "Mailing address: Xinhua Zhu,
249-19 Thornhill Avenue, Little Neck, NY 11362", with check payable to "
Chuanshen Wu" (Limin's husband) and in memory of Limin. Then @朱新华who
serves as a CAHON rep to collect individual personal donations from CAHON
members, then give all together as CAHON member donations to Limin's husband
and her family.
--
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USMedEdu
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发信人: USMedEdu (US_CMGs), 信区: MedicalCareer
标  题: Re: YJZ: 医网情深:5-22-2017病理实习笔记
发信站: BBS 未名空间站 (Sun Feb 11 14:55:47 2018, 美东)


刀评:上一期实习医生刚走,宝宝才一岁的宝妈、从西岸飞来纽约实习的新学员又开始
了。她刻苦勤奋、好学好问、问有质量的问题、主动帮手协助护士和麻醉医生、结果,
第一天就博得诊所医护和职员们的交口称赞!虽然是刚刚踏上新的征程,相信她与前年
和去年的几位宝妈或大龄CMG毕业生一样,会成功!

纽约内科/病理实习第一周笔记

Zoe

2月的第一个周日纽约还下着雨,Lisa和何老师先后到我的住处附近与我见面,周到细
致的与我详谈实习安排。按照何老师设计的内科与病理紧密结合的实习计划,第一天便
在内镜室及何老师在长岛的办公室实习,收获满满。
1. 在胃肠专科医生和麻醉医生指导下的内镜室实习
实习之前何老师为了帮助我更好的融入环境,特别向我介绍了诊所医生,助手和其他医
护人员。首先感受到的是医生与其他医务工作人员之间密切有序的合作和融洽的工作氛
围, 我有机会学习医护人员与病人交流的包括verbal and body language的各种技巧
。在内镜室的半天时间我接触学习到了至少十个病人EGD和colonoscopy内镜下表现,最
重要的是有机会将书本知识与临床实践相结合,结合病人的病史查体来理解内镜的使用
指征,深刻感到这与之前看书相比事半功倍。实习中初步了解了美国尤其是白种人群中
GI outpatient clinic常见的病种,接触到的疾病表现包括esophagitis, gastritis (
including drug-induced), sliding hiatal hernia, gastric erosion, esophageal
ring, colon polyps等。其中有一些在临床中学到的刷新了我以前对某些疾病的理解。
比如sliding hiatal hernia在临床上发生率很高,这次有机会观摩其在内镜下的诊断
,实习后再回头去找临床资料则发现了其中短短一句话的深刻含义,恍然大悟!
见习的同时我还有机会参与到内镜室病人操作前后的临床准备中, 帮助协助麻醉医师
的工作,整个过程下来感觉无形中锻炼了临床技能,可以找各种机会练习口语。通过学
习真实临床情境下医生与病人的互动,感觉对cs的学习和如何用lay language有效简洁
的与病人交流有很大启发和帮助。值得一提的是这次遇到了一个吸烟病人内镜操作中需
要紧急保护病人气道的情况,我不仅亲身帮助麻醉医生的工作,还学到了如何在操作前
评估病人的风险,操作中如何检测和急救,以及如何在操作前后充分告知病人和对病人
及家属进行一系列的consultation。后面医生的consultation live show感觉可谓秒杀
一切照本宣科的cs教程。
2. 在何老师的指导下学习使用两种软件sign out病理报告。
首先何老师一再强调所有病理操作都要严格符合standard operating policy, 病理文
件保存期2年,切片保存长达10至20年; 在工作中一定要严肃认真对待各项程序,是对
自己的专业素养和对病人的负责,也是对自我的保护。使用过的含有任何病人信息的资
料一定要及时销毁!
何老师指导我sign out 十几份不同的病例的过程中讲解了病理工作以及平时学习要注
意的精华要点,用实例说明了medical knowledge在病理工作中的重要性。我初步了解
了GI pathology的诊断语言规范,除此以外根据病人病史提供的重要信息,要注意着重
描述有价值的表现,尤其是阴性表现。
辅导时涉及到的pathology专业知识:
1) Brunner’s gland is shown as the pale stained areas of the submucosa. It
is unique to the duodenum and clearly differentiating it from the other
segments of the small intestine.
 
2) Brunner’s gland hyperplasia vs adenoma
it is clinically important to differentiate Brunner’s gland hyperplasia and
Brunner’s gland adenoma. Brunner’s gland hyperplasia could be easily
mistaken for neoplastic lesions. It is comprised of proliferating glands
with maintenance of a lobular architecture and fibrous septa separating the
hyperplastic lobules. It may sometimes manifest as solitary or multiple
small nodules.

Brunner’s gland adenoma is a rare duodenal lesion comprising less than 5%
of benign duodenal tumors. Most Brunner’s gland adenoma is small size
masses and many patients are asymptomatic. Occasionally, they may be large
in size with clinical manifestations of hemorrhage or obstruction. It is
comprised of nodular hyperplastic Brunner's glands with an unusual admixture
of normal tissues, including ducts, adipose tissue and lymphoid tissue.

3) Fundic gland polyp
It is common in older people and is a reasonable differential for a polypoid
structure in the stomach. Pathologically, it looks like oxyntic mucosa but
with cystically dilated glands.
 
4) Reactive gastropathy
Reactive gastropathy refers to the constellation of endoscopic and
histologic findings caused by chemical injury to the gastric mucosa. 
The histology is characterized by foveolar hyperplasia with edema, smooth
muscle hyperplasia, and congestion of superficial capillaries in the lamina
propria in the absence of significant inflammation.

References:
1. Sobotta/Hammersen Histology. Color altas of microscopic anatomy. Frithjof
Hammersen, MD. Third edition, Urban & Schwarzenberg.
2. https://www.humpath.com/spip.php?article19237
3. The practice of surgical pathology, A beginner’s guide to the diagnostic
process. Diana Weedman Molavi, MD, PhD. 2008 Springer.
4. Sorleto M et al. Brunner’s gland adenoma-a rare cause of
gastrointestinal bleeding: case report and systematic review. Case. Rep.
Gastroenterol., 2017, 11(1):1-8.
5. http://www.histopathology-india.net/bgad.htm
6. Lu L et al. Brunner’s gland adenoma of duonenum: report of two cases.
Int. J. Clin. Exp. Pathol., 2015, 8(6): 7565-7569.
7. Spiegel A et al. A report of gastric fundic gland polyps, 2010, 6(1): 45-
48.
8. Burt RW et al. Gastric fundic gland polyps. Gastroenterology, 2003, 125:
1462-1469.
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标  题: Re: YJZ: 医网情深:5-22-2017病理实习笔记
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标  题: Re: YJZ: 医网情深:5-22-2017病理实习笔记
发信站: BBS 未名空间站 (Tue Feb 13 22:25:07 2018, 美东)


Colon Polyps Summary

2018.02.13 00:06  打开App

By Zoe Z.

跟何老师病理实习刚结束,这一周在Z 医生的胃肠诊所就刚好经历了一位病人从初诊到
内镜下发现 pedunculated and sessile polyp 的过程,结合临床和病理学习做了总结
如下:
Case presentation

A 60 yo female complains of bright red rectal bleeding for 5 months. The
bleeding was intermittent and occurred with bowel movement in moderate
amount. She had rectal pain with defecation and the pain resolved
spontaneously afterwards. She had history of constipation for 2 years but
had one or two bowel movement every day recently. She had dizziness and
short of breath occasionally, but CBC results two weeks ago were WNL. She
had no fever, chills, nausea, vomiting, no recent weight loss, no change in
appetite and diet. She had a balanced diet with vegetables, fruit and meat.

PMH: hypercholesterolemia.

PSH: two cesarean sections 30 and 25 years ago. Hemorrhoids resection 15
years ago

Medications: Statin, NSAIDS.

Allergies: NKDA.

The patient was scheduled for colonoscopy. Two polyps were found. One is a
pedunculated polyp 3cm*1cm at descending colon, resected under the
colonoscopy;another is a sessile polyp 3.5cm*3cm with irregular contour and
superficial bleeding. Resection was attempted but not completed due to the
large size. The patient was scheduled for repeat resection in the hospital.
The biopsies were taken and sent for pathology examination.

Introduction

A polyp of the colon is a tumorousmass that protrudes into the lumen above
the surrounding colonic mucosa. Theymay appear as sessile lesions without a
definable stalk, or they may form as astalked or pedunculated polyp. Based
on the malignant potential, Colon polypscan generally be classified as non-
neoplastic which do not have the malignantpotential, including inflammatory
polyps and hyperplastic polyps; andneoplastic polyps with adenomatous polyps
or adenomas comprising approximatelytwo thirds of all colon polyps.

Clinical features

Colon polyps are usually asymptomatic, but sometimes they may ulcerate and
bleed,causing tenesmus or intestinal obstruction if large. The polyps
including adenomas are most commonly detected by colon cancer screening
tests. The growth rates of different types of polyps, or even the same type
of polyps vary significantly. However, complete regression is uncommon.

Endoscopic presentation and classification

Adenomas may be pedunculated, sessile, flat, excavated, or depressed based
on their gross appearance under the endoscopy. The pedunculated polyp has a
narrow base, with a mucosal stalk between the polyp and the wall. For the
sessile polyps, the base and top of the lesion have the similar diameter.
Regardless of the gross morphology, there are several endoscopic features
suggestive of invasive cancer, including friability, ulceration and
induration. A firm consistency or adherence of the polyp to the underlying
tissue is also a concerning feature for malignancy.

Histological presentation and classification

1. Hyperplastic polyp

Hyperplastic polyps are the most common non-neoplastic polyps in colon. They
are typical located in the rectal-sigmoid colon. Hyperplasic polyps are
white or bland lesions. They usually present as small nodules (< 5mm in
diameter) with nipple-like, hemispheric and smooth appearance, but can be
large up to 2cm in diameter.

Three histologic subtypes have been described, including microvesicular,
goblet cell, and mucin depleted. The prominent feature of the hyperplastic
polyp as a non-neoplastic polyp is the normal architecture and proliferative
characteristics with no dysplasia. Maturation occurs towards the surface,
which is in contrast with adenoma where dysplasia appears on the surface and
extends down the crypt. The epithelial cells pile on the surface along the
length of the crypt, creating a serrated, longitudinal profile and star-
shaped lumen in cross sections. The glands have an increased number of
goblet cells and therefore look pale or cleared out next to normal
epithelium. A polyp with adenomatous-looking cells at the base of the crypts
, and frilly hyperplastic cells at the surface, is still a hyperplastic
polyp.

2. Sessile serrated polyp

Sessile serrated polyp usually has a smooth surface, often flat or sessile,
and may be covered with mucus. Recently,large (>1cm) hyperplastic polyps
occurring in the right colon were recognized as a distinct subtype of polyp
with malignant potential, associated with the microsatellite instability (as
in hereditary nonpolyposis colorectal cancer [HNPCC]) cancer pathway. They
are called either sessile serrated adenomas or sessile serrated polyps. It
basically presents with the architecture of hyperplastic polyp but with
dysplasia. Dysplasia may range from subtle to high-grade. Nuclear detail,
number and location of mitotic figures is necessary for diagnosis.

The crypts have characteristic dilation and branching at the base (“duck
feet”), and the epithelial cells maybe more eosinophilic (less mucin) and
pseudostratified than the usual hyperplastic polyp. However, mature goblet
cells and the frilly surface are still evident.

The difference is in the depth of proliferation: hyperplastic polyps show
mostly surface hyperplasia and expansion, whereas the sessile serrated group
is hyperplastic right down to the base. These are important to recognize,
because they should be treated clinically like an adenoma, not just a
hyperplastic polyp.

3. Adenomas

An adenoma (at least in the tubular-to-villous family) is defined as a polyp
with low-grade dysplasia. Low-grade dysplasia in the colon indicates a
cytologic change and stands out from normal colon as looking blue on the
slide. Dysplasia begins abruptly on or near the surface and grows along
crypts toward the base. The cells lining the crypts and the surface become
tall and dark (because of depleted mucin) and have cigar-shaped and/or
pseudostratified hyperchromatic nuclei. Mitoses may be present but are
generally not apical.

In tubular adenomas, dysplastic epithelium spreads downward and the surface
remains relatively smooth. Villous adenomas grow on delicate stromal fronds.
Tubulovillous adenomas display combinations of these architectural patterns
, with villous sand tubular components accounting for more than 20% of the
polyp. The greater the villous component, the greater the tendency for
malignant change.

Management, prognosis and surveillance of different types of polyps

1. Hyperplastic polyp

Although small rectosigmoid hyperplastic polyps do not appear to increase
the risk of colorectal cancer, Small hyperplastic polyps are typically
biopsied or removed during endoscopy with biopsy forceps because they can be
difficult to differentiate from adenomatous polyps based on the appearance.

Surveillance colonoscopy is recommended in 10 years in the U.S. for patients
with small (<10mm) hyperplastic polyps confined to the rectum or sigmoid
colon.

2.  Sessile serrated polyp

Sessile serrated polyps with foci of dysplasia are considered the likely
precursor lesions to sporadic microsatellite instability-high colon cancer.
It is believed that a molecular pathway with a high frequency of methylation
of CpG islands is involved. In particular, lesions with size more than or
equal to 10mm, located in the proximal colon or with the presence of
dysplasia possess higher risk for asynchronous advanced adenoma.

Due to the malignant potential it carries, this type of polyps is managed
clinically like adenomatous polyps and complete excision is recommended.
Considering its indistinct border, it is important to make sure the complete
removal during the endoscopy procedure.

Patients with size of the polyp less than 10mm AND with no dysplasia are
surveyed with colonoscopy in five years, similar to low risk adenomas.
Whereas patients with size of the polyp larger than or equal to 10mm or with
dysplasia are screened by colonoscopy every three years, as to the
management of high-risk adenomas.

3.  Adenomatous polyp

Only a small minority (less than 5%) of adenomas progress to cancer over 7
to 10 years. In general, the risk of progression is higher for advanced
adenomas with high grade dysplasia, more than 10 mm in size, or with a
villous component.

In principle, adenomas should be resected completely. Small adenomas may be
removed by biopsy forceps. For larger adenomas, snare resection with or
without electrocautery or other advanced endoscopic resection may be
required. If endoscopic resection is not possible,surgical resection is
required.

Surveillance depends on the comprehensive evaluation of the risk of the
adenoma. For low-risk adenomas, that is, only one or two small (<10mm)
tubular adenomas found by colonoscopy, the first surveillance colonoscopy
should be performed in 5 to 10 years. On the other hand, patients with an
advanced adenoma or 3-10 adenomas found on colonoscopy, the first
surveillance should be performed in three years. Patients with more than 10
adenomas should be screened in less than three years, and meanwhile must be
evaluated for a hereditary colorectal cancer syndrome.



2/12/2018 于美国纽约




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标  题: Re: YJZ: 医网情深:5-22-2017病理实习笔记
发信站: BBS 未名空间站 (Tue Feb 13 22:32:11 2018, 美东)


【 在 Medflorida (Medream) 的大作中提到: 】
: 赞!



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【 在 USMedEdu (US_CMGs) 的大作中提到: 】



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标  题: Re: YJZ: 医网情深:5-22-2017病理实习笔记
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【 在 USMedEdu (US_CMGs) 的大作中提到: 】
: 离金榜题名2018 Match Day不到一个月了,参加今年match的同学们,我和34位同行医
: 生朋友祝福你们新年快乐、如意、成功!



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标  题: Re: YJZ: 医网情深:5-22-2017病理实习笔记
发信站: BBS 未名空间站 (Thu Feb 15 00:32:49 2018, 美东)

这个月的实习医生不仅刻苦勤奋、而且确实心灵手巧。今天带教冰冻切片,上午练习了
切腊块儿,下午第一次接触冰冻切片,仅仅切了20来次,就基本掌握了手法,切的很好
了。图5是冰冻切片(自己做的染色)、图6是自己切和染的石蜡包埋切片。很好的病理
住院医生苗子……
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标  题: Re: YJZ: 医网情深:5-22-2017病理实习笔记
发信站: BBS 未名空间站 (Fri Feb 16 01:44:55 2018, 美东)


医网情深: 从错误中学习——纽约病理实习第二周笔记

Zoe


国内正是除夕佳节,何老师载我去胃肠诊所并带上蛋糕和鲜花与所有工作伙伴们一同分
享,其乐融融。

这一周继续内科加病理相辅相成实习,我不仅在何老师的耐心指导下加深对病理的理解
,还在病理实验室学习切片染片各种技术和GI以外的其他有趣病例,另外何老师的模拟
面试辅导让我受益匪浅。 总之更深刻理解到实习和以后的学习工作既要“脚踏实地”
地提高专业素质,也要“仰望星空”,对自己正在和将要从事的工作有更宏观和深入的
理解。
 
每次去诊所的路上都是宝贵的学习时间。何老师由之前我刚学习的colon polyp讲起,
传授了很多阅片诊断的逻辑思路和正确习惯,让我有茅塞顿开之感。虽然基本功还需要
通过无数的阅片磨练,但是从一开始建立正确的思维方式则是磨刀不误砍柴功。当然,
进步的道路总是曲折的。

何老师多次强调组织学是重中之重,我自己在这周实习阅片的错误中也深有体会。虽然
之前复习了一些教学图片,但临床病例多种多样,因为基础还不过关,老师让我自己阅
片时就开始频频犯错。这周实习之余继续恶补组织学,复习不同细胞形态到不同组织尤
其是GI tract的defining features,然后再到显微镜下重新回头看何老师准备的教学
片,有疑惑重新看书或查资料,如此反复。结合阅片学习总结如下:

1. 首先阅片习惯从低倍到中倍到高倍最后在回到低倍。先确定哪种组织,对于胃肠系
统,结合何老师的讲解和参考书,我感到最有效的方法是观察上皮形态结构和重要腺体
的不同特点:esophagus is lined by stratified squamous nonkeratinized
epithelium, 固有层较薄。Stomach fundus是分泌粘液的单层柱状上皮皱襞,固有层有
大量gastric glands,其中可见parietal cells and chief cells;而pyloric
stomach的皱襞和gastric pits比funus更深,底部卷曲,固有层的幽门腺体密度比胃底
腺体更低,显得更疏松。从十二指肠小肠到直肠,柱状上皮形成villi,出现goblet
cells, 小肠的绒毛上皮很长而结肠很直相对短。这里特别提醒自己注意的是,虽然第
一次何老师已经讲解得非常清楚,而且我也曾在镜下看过十二指肠 brunner’s glands
,但再次自己阅片时仍然不自信会混淆,自己找原因主要是阅片时没有第一时间抓住组
织学基本层次,brunner’s gland应为在submucosa 聚集的小圆形腺体,不应该与其他
mucosal gland混淆(而当hyperplasia时腺体增生可能会延伸达到上皮部位)。

 

Figure 1. Duodenum                 &
#160;                    
   Figure 2. Duodenum (PAS stain)
2. Fundic gland polyp (FGP) vs gastric hyperplastic polyp (GHP)



 
Figure 3. FGP                  
                     
;     Figure 4. GHP

两者共性是腺体都会扩大变形。但是如果正常组织学概念清晰,则区别也显而易见:从
命名上看两者起源就不同。首先必须对胃底fundic gland和胃窦胃体的腺体形态了熟于
心,才能判断是哪部分病变。胃底的正常腺体较小,细胞嗜酸性,腺腔很小;而胃窦/
体腺体较大,其柱状上皮与表皮的上皮细胞相似;在病变扩张情况下,即使两者的腺体
细胞都可能挤压形变,但是hyperplastic polyp的腺体仍有柱状上皮的特点和空泡的存
在。

3. chronic active gastritis
之前何老师讲过一个胃炎严重炎症反应怀疑HP感染,初染阴性复染阳性的case,印象很
深刻;这次则通过阅片暴露了自己的不足,也加深了理解。




 
这里重要的两点需要鉴别的基本概念上的问题,第一是良性炎症反应和恶性(肿瘤等)
病变的区分,即慢性胃炎可见大量弥漫性淋巴细胞浸润,但是与恶性肿瘤病变的重要区
别在于淋巴结结构清晰,具有生发中心(如本病例所见)。第二,活动性与非活动性炎
症的鉴别在于是否有中性粒细胞浸润。观察腺体细节,可见腺体已有分叶核中性粒细胞
浸润。 HP染色也证实了活动性H. pylori感染,与组织学活动性炎症表现相符。
 
在面试方面,何老师对我回答每个问题暴露出的缺点和不成熟的地方一一指出,从表象
的坐姿手势到谈话内容和方式。同时也强调“好的面试者就像好的演员一样也需要反复
演练,真正把自己融入到情境中”。我感到自己还要下很大功夫反复磨练,尤其是如何
用最精炼、有逻辑、又有感情的语言讲故事表达自己,如何不浪费每次面试谈话的机会
不动声色地展示自己的优势,发掘和项目之间的chemistry, 如何把劣势转化为优势等。

另外难得的是除了这些具象化的指导,在带教和交流过程中何老师根据我的背景和经历
帮助我发掘自己可以和临床工作相结合的优势,非常有启发性,经提点我在自己还不甚
清晰的思维里搜寻到可以利用起来进一步打磨的具体事例。而关于对要申请的学科的理
解,通过交流学习我感到这个回答要反映自己在学习工作过程中看待问题的视野和视角
,要像何老师所说的通过实例把回答升华到一个高度,才能让对方印象深刻。这些收获
我仍需要反复体会,温故知新。
 

2/15/2018 于美国纽约
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标  题: Re: YJZ: 医网情深:5-22-2017病理实习笔记
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医网情深:腺瘤的病理学习笔记——纽约实习日志

Zoe


两周的病理实习中幸运见到几例典型的tubular adenoma, tubularvillous adenoma
and villous adenoma with high-grade dysplasia的病理切片。结合阅片系统地学习
了各种colon adenoma和adenocarcinoma的重要组织形态学特点和鉴别依据。其中high-
grade dysplasia的病例由于取材表浅无法确定是否有invasion而满足adenocarcinoma
的诊断,从而再次学习到如何在sign out report中给出严谨而准确的诊断描述。

另外何老师立即加做MSI-H testing, 结合之前面试辅导中何老师和我谈到分子诊断在
病理学中的重要性很有启发,我也对现在临床上应用的对结直肠癌治疗和预后有重要作
用的分子标记非常感兴趣。这里将colon adenoma和adenocarcinoma的组织学特点,发
生机制及临床上应用的分子诊断标记及其临床意义总结如下:

Introduction
Colorectal cancer (CRC) is the third most common cancer in both men and
women in the U.S. and it is also the third cause of cancer death in the U.S.
The majority of CRCs are carcinomas, with more than 90% of which are
adenocarcinomas. Understanding the risk factors, progression, pathology and
molecular diagnostic markers are extremely important in guiding the
management and prognosis of colorectal cancer.

It is well accepted that most human CRCs undergo the adenoma-carcinoma
sequence and arise from dysplastic changes of the adenomas. This occurs when
the normal cell renewal pathways become dysregulated in the colon
epithelial cells. It is critical to recognize the cell growth patterns in
different types of adenomas and adenocarcinomas for accurate diagnosis and
prognostic evaluation.
Figure 1. The adenoma-carcinoma sequence
Histological features of Adenoma
An adenoma is a polyp with low-grade dysplasia. The key morphological change
includes the tall and dark cells lining the crypts, and the surface with
cigar-shaped or pseudostratified hyperchromatic nuclei.
Depending on the histology and architecture, Adenomas can be classified into
tubular adenoma, villous adenoma and tubularvillous adenoma.
Tubular adenomas consist of more than 80% of colonic adenomas. They present
with smooth surface and parallel crypts. The tubular adenomas typically have
at least 75% of tubular component. By definition, villous adenoma should
have at least 75% of the villous component. Morphologically, villous adenoma
is covered by the long finger-like projections; the glands extend straight
down from the surface to the center of the polyp. Tubularvillous adenomas
present the mixed features of both tubular and villous adenomas and they
account for approximately 5-15% of all colonic adenomas. An advanced adenoma
is defined as adenomas with the size larger than 10 mm, or with villous
components or high-grade dysplasia.

High-grade dysplasia can be considered as an intermediate step of
progression between low-grade dysplasia and cancer. Strictly speaking, it is
diagnosed based on architecture rather than cytology. Usually the term high
-grade dysplasia is used when the lesions are confined to the epithelial
layer and no invasion through the basement membrane can be proven. High-
grade dysplasia is often accompanied by ugly cytology, such as total loss of
nuclear polarity, significant pleomorphism, atypical mitoses figures and
prominent nucleoli.

Figure 2. Tubular adenoma          
Figure 3. Normal colonic mucosa (left); tubular adenoma (right)
Figure 4. Villous adenoma

Figure 5. Tubularvillous adenoma
Histological features of Adenocarcinoma
To diagnose adenocarcinoma instead of high-grade dysplasia, one must prove
the invasion of the cancer cells across the muscularis mucosae (if can be
identified) into the submucosa. Cancer cells in submucosa rich in blood
vessels and lymphatic tissues poses the risk of progression and metastasis.
However, if the biopsy is superficial or poorly oriented, invasion can be
very difficult to identify. Another important feature of invasion is
desmoplasia or desmoplastic reaction with prominent fibrous proliferation,
instead of the loose connective tissue around the cancerous cells.
Molecular features of colorectal cancer
Clinical studies suggest that molecular features may be of crucial
prognostic value for CRCs, independent of cancer staging. However, more
comprehensive statistically valid clinical studies are still needed before
many molecular or genetic markers can be used in clinic. Of note, currently
only the mismatch repair proteins (MMR), BRAF and RAS mutations are proven
to be useful for clinical decision-making.
1. MSI-high (MSI-H)
Nowadays the MMR (mismatch repair) status testing in patients with CRC is
routinely ordered for prognostic stratification and/or for identifying
patients at high risk for Lynch syndrome. MSI is one of the clinically
important prognostic factors recommended in the newest 2017 TNM staging
criteria for CRC.
The term MSI refers to Microsatellite instability. An important feature of
the cells with mismatch repair defect is the accumulation of abnormalities
in short sequences of nucleotide bases, repeating dozens to hundreds of
times within the genome. These clusters of sequences are called
microsatellites. Genes critical for cell growth regulation may contain
microsatellites in the promoter region and they are susceptible to
frameshift mutations.
A panel of several microsatellite loci were used for testing the MSI. A
proposed standard test is consisted of three dinucleotide repeats and two
mononucleotide repeats. In this case, a MSI-H (MSI-high) tumor is defined as
having at least two (40 percent) foci affected by instability. If less than
40 percent of foci is affected by instability, it is called MSI-L (MSI-low)
instead. However, most tumors show either high degree of instability or no
unstable markers. MSI-L tumors only represents a minor tumor population,
with no MMR defect.
The majority of Lynch syndrome and approximately 15% of sporadic tumors are
MSI-H. In particular, sporadic tumors with MSI-H have several characteristic
clinical and pathological features, including the tendency to occur in the
proximal colon, a greater mucinous component, lymphocytic infiltration, and
more likely to be poorly differentiated. Despite the tendency to be poorly
differentiated, interestingly, MSI-H localized CRCs are associated with
better prognosis and longer survival in both Lynch syndrome and sporadic
colorectal cancers.  The biological basis for this finding is unknown. For
metastatic CRC, the prognostic value of MSI is less clear.

2. RAS and BRAF
On the other hand, RAS and BRAF mutations are useful for predicting
prognosis in metastatic CRC. KRAS mutations involving either codon 12 or 13
is associated with a worse prognosis in a majority of clinical studies.
Furthermore, KRAS and NRAS mutations suggest poor response to anti-EGFR
therapy. The molecular basis lies in the EGFR signaling pathway responsible
for colon tumorigenesis. RAS mutation downstream of EGFR results in the
constitutive activation of this pathway regardless of the blockade of EGFR.
Therefore, RAS mutation testing is ordered for CRC patients considering anti
-EGFR therapy.
BRAF V600E mutation also confer resistance to anti-EGFR therapy. In MMR
deficient tumors, BRAF V600E mutation is particularly useful for evaluation
of lynch syndrome risk. Lynch syndrome do not possess the BRAF V600E
mutation; and therefore, the presence of BRAF V600E strongly indicates a
sporadic CRC. It is also found to be prevalent in smokers.
In summary, the comprehensive molecular classification system is not yet
incorporated into the CRC staging system. However, the molecular tumor
classification has undergone a lot of progress and potentially contributes
to the development of the new molecular prognostic stratification system and
target specific therapies.


2/16/2018 于美国纽约

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标  题: Re: YJZ: 医网情深:5-22-2017病理实习笔记
发信站: BBS 未名空间站 (Thu Mar  1 02:34:28 2018, 美东)

医网情深:纽约病理/内科实习第四周随感

Zoe


实习近尾声,我试着从最初的兴奋渐渐沉淀巩固,继续巩固提高自己对临床病理和内科
的认识。
 
这两周何老师给我以前学习过的tubularvillous adenoma, brunner gland adenoma,
chronic active colitis和chronic gastritis with intestinal metaplasia的病理片
让我判断, 锻炼我识别和举一反三的学习方法。之前何老师讲解组织学和相关病变的精
要特点后我又在教科书和网上找类似的病例继续体会学习,基本上给出了正确描述,重
要的是初步形成阅片的逻辑思路,体会了努力后的小喜悦。但我还不够熟练,更感到做
一个合格的病理医生需要经年累月临床上的锤炼。

何老师还带我学习了GI系统以外有趣又有教学意义的cases, 开拓视野学到新经验的过
程非常愉悦。比如melanosis coli, 看到了典型的充满lipofuscin棕色色素的巨噬细胞
,以前对此在书本上的印象变得更立体起来;bladder papillary carcinoma在整体碎
片样的组织切片中寻找到类似于正常泌尿上皮的结构和乳头样癌变部位,同时学习到对
于carcinoma的描述中至关重要的对组织浸润深度的判断,一定要报告是否有
muscularis propria invasion。看到了胸水涂片和沉渣组织片,以及其中恶性细胞的
形态特征等等。
 
内科实习中我有机会在不同诊所观摩内镜操作和病人问诊,切身体会到美国的临床文化
。首先communication is the key to the every aspect in clinical practice. 医
生与病人之间的相互尊重的是真实体现在所说每一句话的字里行间的。记得Dr. L每次
见到回诊病人都像见到自己的老朋友,每个病人都有自己独特的工作和生活爱好,一句
与病人生活相关的问候立即拉近了相互之间的距离。Dr. F问诊中每次都能用简练通俗
易懂的语言站在病人的角度解释为什么怀疑这个病?为什么下一步要做这个操作,采取
这个治疗?比如一个怀疑 SIBO的病人,医生解释要做trial antibiotics trial,但病
人仍然关于如何确定自己的病因不理解有疑问,医生便耐心解释: now you do not use
antibiotics, you feel like this; then you use antibiotics for a while, you
feel like that. Then we would be able to tell…”病人就完全理解了这样治疗的
意义,更重要的是理解之后才更能增强病人自己治疗疾病的信心和提高依从性。

另外不管是在哪个诊所实习,医生都把病人安全永远放在最重要的地位,没有之一。我
们常说医生是save patients’ lives, 是吗?是的。但是在繁杂琐碎的日常工作中,
patient safety是最基本的底线。实习中小到prevent patient falls, 到及时汇报病
人的生命指征,到在procedure之前有针对性的问诊以及时发现潜在风险并预防,大到
紧急情况下标准处理流程,都需要整个团队一起协作共同完成。不仅保证病人安全,也
保证临床工作安全有序的进行。这一点其实不论内科病理还是其他临床学科应该也是共
通的,因为临床直面病人,处理的都是最严肃的生命相关的问题。这让我联想到何老师
对我们如何在临床训练中生存的经验之谈:在临床中学习,有时候不怕不会做,而怕“
too smart”; 不确定的时候要及时沟通,不造成不能挽回的错误。

最后我还是想说,扎实的医学知识和临床经验是一个好医生可以有效交流和保证病人安
全的基石。就临床看到的简单例子:如果想到RA病人除了关节受累也可能累及全身重要
器官,就会注意操作前做一些气道保护措施;如果内镜下看到一个按要求进食的病人还
是有很多食物残渣,进一步问出糖尿病病史,就要想到糖尿病相关胃轻瘫,帮助病人发
现问题缓解痛苦等等。

我感到上面任何一个医生的素质能做到完美已属不易,如果都做到了,那就像何老师一
直强调的,做一个好医生是一项艺术。之前忙里偷闲周末去博物馆,时间很短馆藏珍品
仅能浮光掠影地游览。但是不经意间发现一句话,简直与医生如何看待医学如出一辙!
这个有趣的project讲述了120位艺术家面对艺术品的感悟——他们的体验各不相同,但
都有一个共性,就是:

“they know how to unpack a work not only analytically but also emotionally.
They have a way of making it personal.”

我们学习的时候“unpack a case analytically”, 研究病例背后的知识和经验并积累
起来,就像是精雕细琢艺术品的一个个细节;但是最终当我们practice medicine 时,
一个好的医生能够让医学艺术具备灵魂的,却是”unpack a case emotionally”, 并
“make it personal”。

我希望做这样的医生,以此自勉。


2/28/2018 于美国纽约




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标  题: Re: YJZ: 医网情深:5-22-2017病理实习笔记
发信站: BBS 未名空间站 (Fri Mar  2 16:00:16 2018, 美东)


【 在 USMedEdu (US_CMGs) 的大作中提到: 】
: 最后的一天……
: 又一个实习医生结束了一个月的强化训练要结业回去了。心细的她给诊所医护带去鲜花
: 💐和大蛋糕表示感谢他/她们的热情接待和辅导。和我一起开车去诊所办公室的
: 路上听乐曲发现CD已开始磨损失真,给我一盘我最喜欢的Andy Williams的歌曲集、还
: 有一本大都市艺术博物馆出的艺术大师集锦工作日历手册。一个非常勤奋好学、聪慧知
: 性的同学!一个一定会成功的宝妈CMG!虽然仅仅一个月的教和学的时间,却也是人生
: 历程中的一个美好的回忆和插曲……
: 正如Andy 唱的那首脍炙人口的歌——
: A time for us, someday there'll be
: A new world, a world of shining hope for you and me
: ...................



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发信人: USMedEdu (US_CMGs), 信区: MedicalCareer
标  题: Re: YJZ: 医网情深:5-22-2017病理实习笔记
发信站: BBS 未名空间站 (Mon Mar  5 00:38:59 2018, 美东)

还有一周时间,就到了一年一度的美国住院医生录取的Match Day!看到同行胡医生贴
的这个新年心愿祝福贺卡,觉得非常适合给所有抱有梦想、心怀理想、并为之艰苦奋斗
和努力的CMG同学们、也适合给那些彷徨迷茫犹豫不决瞻前顾后的同学们……
祝参加今年match的CMG同学们梦想成真,如愿以偿,不辜负自己这多年的努力和付出!
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标  题: Re: YJZ: 医网情深:5-22-2017病理实习笔记
发信站: BBS 未名空间站 (Tue Mar  6 17:16:30 2018, 美东)

医网情深:一份特殊的感谢卡及其他——十年里那些让我难忘的朋友们(11)

力刀


我经常收到各种各样的感谢卡和小礼物。

而这个月,这位从西海岸飞过来的学员、一个孩子才一岁的宝妈,在她实习结业时给我
的感谢卡,却是最感动我的一个!

我曾写过一个短文,谈及这个“孩子边扔着小鱼边说:它在乎!”把沙滩上的小鱼拾起
来一一扔回海里的著名的寓言故事。她不仅看到了我的短文,记住了,而且一定是费了
心血和时间找到这样一个特殊的感谢卡作为礼物给我……!

是的,有许多人历尽千辛万苦进到了医生行列(北美有7000人左右的华裔医生)就不再
在乎别人了,可有更多的CMGs在苦苦挣扎着希望进入这个职业圈,我一年也就能亲自带
教辅导10到20多个学生,工作和生活之余的有限时间内电话或会议辅导,确实能帮助的
人也很有限,但是,对于这每一个个体而言,培训他们的成功就是“made a
difference for that one”!

她随我每周两次去长岛里面办公室的路上,我们会云天雾地地闲扯唠嗑,话题除有关住
院医师、面试、也涉及其它方面。我也会从我个人经历故事谈起来启发她对这个职业生
涯的认识。,也谈及艺术、体育……

她周末去曼哈顿的大都会艺术博物馆参观,带回来一本艺术大师集锦工作手册最为小礼
物。然而,不仅仅如此,在参观浏览中,她能够发现具有哲理性的东西,并于自己未来
的职业结合考虑——

“忙里偷闲周末去博物馆,时间很短,馆藏珍品仅能浮光掠影地游览。但是不经意间发
现一句话,简直与医生如何看待医学如出一辙!这个有趣的project讲述了120位艺术家
面对艺术品的感悟——他们的体验各不相同,但都有一个共性,就是:
“they know how to unpack a work not only analytically but also emotionally.
They have a way of making it personal.”

我们学习的时候“unpack a case analytically”, 研究病例背后的知识和经验并积累
起来,就像是精雕细琢艺术品的一个个细节;但是最终当我们practice medicine 时,
一个好的医生能够让医学艺术具备灵魂的,却是”unpack a case emotionally”, 并
“make it personal”。

我希望做这样的医生,以此自勉。”……


这确实不是一般同学能做到的境界!有如此学生,实是为师我之幸!谢谢你的理解!

我又何尝不是从这位学生那里学到了一些有益的东西?!

让我们共同努力,来“make difference for ourselves as well as this world”!

A time for us!
…………


3/3/2018 于美国纽约 刀客聊斋

https://m12.girtu.com/post/show/5a9a208ce5efa41f2e691ab4?code=
0017SCKP1po5b91dPaHP1impKP17SCKA&state=getu


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发信人: USMedEdu (US_CMGs), 信区: MedicalCareer
标  题: Re: YJZ: 医网情深:5-22-2017病理实习笔记
发信站: BBS 未名空间站 (Fri Mar  9 01:24:10 2018, 美东)



医网情深:美国第一位女性医生——伊丽莎白.布莱克威尔

力刀 编译

Elizabeth Blackwell (3 February 1821 – 31 May 1910) ——第一位从美国医
学院毕业取得医学博士证书取得美国行医资格、也是一位不列颠女医生,并且是努力促
进妇女参加医学教育的先驱、更是美国和英国社会和道德改革倡导者。

伊丽莎白出生于英国,布里斯托,父亲是制糖工人,但是对于孩子的教育、爱好、兴趣
和天赋发展采取非常开明,自由的态度。她在家中排行老三。1832年从英格兰移民至美
国纽约,后搬到辛辛那提定居。从小到大,她兴趣广泛,当过教会、写作、音乐和艺术
教师。在北卡教书的过程中,在一位医生那里接触到医学书籍,离开触发了她对医学的
兴趣。她搬到费城,跟随William Elder和Jonathan M. Allen
医生私下学习解剖学。同时到处申请医学院,却都被无情地拒绝,那时,医学界对于妇
女学医有种强烈的抵触,认为女性智商低下,不足以应付医学职业的竞争挑战。许多医
生建议她去巴黎学医或甚至女扮男装来学医!她曾回顾道这段历史:“As to the
opinion of people, I don't care one straw personally; though I take so much
pains, as a matter of policy, to propitiate it, and shall always strive to
do so; for I see continually how the highest good is eclipsed by the violent
or disagreeable forms which contain it.”

然而,她坚持不懈地努力,终于在1847年20月被纽约上州的Hobart College,后改名为
Geneva Medical College接受。说来也富有喜剧性,当时校长和教职人员难以决定是否
录取她,就把这个决定交给同届150名男生无记名讨论决定,如果有一位男生反对,她
就将无资格入学。然而,150名男生居然全体通过同意接受她!

然而,在校学习期间绝非易事,她被镇里人们和同学视为怪人,而且她自己也不愿与他
人接触交流非常孤独自闭。学习暑假期间,她回到费城继续跟随William Elder
医生学习临床。并经过种种努力获得在当地市政资助的穷人医院工作,主要医治护理梅
毒和伤寒病人。在这个过程中,她获得了丰富的临床经验。她的毕业论文题目就是论述
伤寒,而且结论讨论了患者机体疾患与社会和道德的关系及影响。这方面的研究思考与
她其后医学生涯的医疗及社会改革有着密切联系。

1849年,1月23日,伊丽莎白终于毕业,成为美国历史上第一位获得医学博士证书的女
性。校长查尔斯.李医生颁发证书与她,并向她鞠躬致敬!当地媒体也赞誉地报道了她
的毕业经历。

同年夏天,她决定赴欧洲继续接受医学教育,但仍然受到严重的歧视。最终她获得一个
产科医院作为助产士而不是医生的位置。她的努力、勤奋和聪慧使得她受到当时著名的
产科医生Paul Dubois夸赞,认为她将会在美国成为最好的产科医生。然而,天有不测
风云,在一次接生一个感染淋病的新生儿时,污染液体溅入她的眼里,导致严重感染并
因此摘除了左眼,这使得她失去成为外科或产科医生的可能。她于1851年又回到了纽约
开始她的独立行医生涯。开始时期仍然受到世俗眼光和歧视,病人很少。她行医之余,
写作发表了第一部著作“The Laws of Life with Special Reference to the
Physical Education of Girls”讨论女孩机体与思维发育、年轻妇女为成为母亲需要
的教育——尽管她自己从未有过婚姻和生育!

1853年,伊丽莎白在曼哈顿下城的Tompkins Square开了自己的小诊所,并录用了也希
望学医的波兰籍女性Marie Zakrzewska为助手。1857年又加上妹妹艾米丽——第三位获
得美国医学博士学位的女性——把原先的小诊所扩展为”纽约贫困妇女和儿童医院”,
接受门诊和住院病人、培训护士、女性参与院董和兼职临床医生。次年,患者人数即成
倍增加。而且,她数次返回英国,集资募捐希望在英国也办起类似她在美国办的贫困妇
女儿童医院。并于1858年,根据新签署通过的认可1858年以前的外国医学教育学历医生
资格法律,她成为1859年第一位注册的英国女医生,并于1874年,开办了英国第一个妇
女医学院:伦敦妇女医学院。但由于内部纷争,她失去了医学院的领导权势,与1877年
辞职退休,终结了自己的医学生涯。

1880至1895年期间,她热衷于道德改革、性纯洁、卫生、和医学教育以及预防医学、优
生/计划生育、女权运动、医学伦理、及反对活体解剖等运动,但因其近于偏执的宗教
情节而成效甚微。而且,她的后期过分要强的个性、对于他人甚至自己的妹妹、曾经的
好友,著名的护理先驱南丁格尔也经常口出恶言使得别人与她交往越来越困难。

她一生未婚未育,领养了一位有点耳聋的爱尔兰女孩Katherine "Kitty" Barry (1848-
1936)相依为命。1910年5月31日,她因中风去世。著名的医学期刊“不列颠医学杂志”
和“柳叶刀”都登载了她去世的卜告。

谷歌与2018年2月3日,以她为主题的画作作为当天的logo——为纪念伊丽莎白197周年
诞辰,第一位经过无比艰难的历程,完成正规医学院教育、取得美国和英国第一位注册
医生资质的女性!

仅以此文献给所有为争取进入美国住院医生的中国女医(学)生们!


3/8/2018 于美国纽约 刀客聊斋

编译自:https://en.m.wikipedia.org/wiki/Elizabeth_Blackwell











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标  题: Re: YJZ: 医网情深:5-22-2017病理实习笔记
发信站: BBS 未名空间站 (Sun Mar 11 01:07:56 2018, 美东)


明天就是match day啦。我这两年带过一些CMG实习医生,个人感觉都还是不错的,尽管
有的毕业
时间长或分数不是很高。我想大家都可以理解,甚至我们自己当年也是类似情况。如果
有Drop机
会,有条件和power的同行,望能给予这些CMG一个试一下的机会!拜托各位朋友和同行
啦!作为
一共才7千人不到的CMG医生群体,我们真该象印度医生学习,不拉自己的同胞进来,我
们个体再
优秀,也只是极有限的影响!每一年的这一天,我都几乎上午不工作,时刻关注Match
的消息,与
那些录取的同学分享第一时间的喜讯和快乐,与他们一起欢呼,也一起流泪……。借用
那著名的一
句歌词:团结起来,到明天……
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USMedEdu
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我的博客
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发信人: USMedEdu (US_CMGs), 信区: MedicalCareer
标  题: Re: YJZ: 医网情深:5-22-2017病理实习笔记
发信站: BBS 未名空间站 (Mon Mar 12 11:06:50 2018, 美东)

2 of my students matched, both >15 yrs, with 2 kids, one with low scores and
2 failures, one was pregnant during externship and baby infant during
interview period.....

cong!

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USMedEdu
进入未名形象秀
我的博客
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发信人: USMedEdu (US_CMGs), 信区: MedicalCareer
标  题: Re: YJZ: 医网情深:5-22-2017病理实习笔记
发信站: BBS 未名空间站 (Mon Mar 12 15:18:17 2018, 美东)

5 old CMF for Path, one young one for IM.


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