Chapter 228 - 153: Dr. Jiang
"Okay, no problem."
Wang Xiaoqing hesitated a moment, then asked as if it were a casual thought, "By the way, there's a provincial commendation conference in the middle of the month, you know about it, right? You're on such good terms with Elder Zhi; will he be attending?"
Jiang He blinked. "I'm not sure."
Wang Xiaoqing sighed. "If only he could be there... I'd love to ask Elder Zhi a few things in private. Oh, well..."
Jiang He silently shuffled half a step to the side, pretending to look at the ceiling, as if he couldn't hear her.
Zhang Zhiyuan, the director of student affairs, saw an opening and tried to make his presence felt:
"Haha, seeing Jiang He achieve so much now, I'm truly the most gratified. I remember, I was the one who personally took Jiang He's perfect-score exam paper to show Director Yang. As they say, 'Fine steeds are common, but a discerning eye is rare.' While I wouldn't call myself a discerning eye, I did help build the bridge and guide the way, haha."
His attempt to claim a connection was painfully obvious.
Principal Qian Suzhi had finally heard enough.
In a steady voice, he said, "That's enough. This is a dissertation defense. Let's all maintain a bit more decorum here."
As soon as the principal spoke, the professors immediately composed their expressions and sat up straight.
The atmosphere in the conference room finally started to feel like a Hell-level examination.
Qian Suzhi opened the file in front of him and began to read out the defense's rules and procedures in a very serious tone.
"This special defense for accelerated graduation aims to comprehensively evaluate the student's overall abilities in multiple areas, including clinical practice, basic scientific research, and medical ethics..."
Jiang He stood at the front of the room.
He stared straight ahead, but his eyes secretly drifted away. He didn't dare look at Principal Qian Suzhi's face.
Because whenever he saw Principal Qian's deadpan face, coupled with his dramatic, rhythmic tone... he couldn't help but think of some absurd comedy sketch.
'Damn it...'
Jiang He pinched his thigh to keep himself from laughing out loud on such a solemn occasion.
"That concludes the reading of the procedures."
Qian Suzhi closed the file and looked at Sun Changming. "Professor Sun, you may begin."
Sun Changming nodded and got straight to the point:
"Jiang He, I've read your paper on LNR many times. The 20% high-risk threshold you've set is statistically very elegant. However, the reality we face is that many local hospitals performing radical resections for colorectal cancer simply don't clear the required twelve lymph nodes."
Sun Changming paused, then threw out the first question:
"If a patient is referred from a local hospital where the lead surgeon only cleared four lymph nodes, one of which is positive, then according to your LNR theory, the ratio is 25%. That's greater than 20%, classifying them as high-risk. But in reality, this is likely a false high-risk caused by an incomplete resection. For a clinical case like this with a severely insufficient number of samples, how should your LNR model be corrected? And as a doctor, how would you formulate the subsequent chemotherapy plan for them?"
As soon as this question was asked, Yang Xu, who was observing, frowned slightly.
'Old Sun's question is a tricky one.'
'In '08, the standardization of surgical procedures is still a work in progress.'
'Provincial capital hospitals encounter this kind of "substandard resection" mess every day.'
—Just like that medical dispute from the other day.
Jiang He replied without missing a beat:
"Professor Sun, for patients with fewer than twelve cleared lymph nodes, we can introduce a log-odds algorithm, adding the absolute number of negative lymph nodes as a weighted variable in the denominator."
Jiang He reined himself in a bit.
He didn't directly bring up the LODDS system, which would only mature several years later; that would be a bit too advanced.
He broke it down in the simplest terms he could. "To put it simply, the fewer negative lymph nodes are cleared, the higher the risk coefficient weighting the model will assign."
"As for formulating the clinical plan..."
"For a patient with a substandard resection and a positive node, we can't afford to be optimistic. I would immediately discard their original N1 stage standard adjuvant chemotherapy plan and treat them as a high-risk N2 case. I'd put them directly on a potent two-drug regimen of oxaliplatin combined with fluorouracil. At the same time, I would recommend the patient undergo frequent abdominal CT follow-ups within three months to monitor for retroperitoneal recurrence."
Sun Changming listened, then blinked meekly.
Not only had Jiang He's answer provided a way to correct the algorithm, but it had also offered clear, clinically safe treatment guidelines.
'The key is, I can't find a single flaw in it.'
'So what am I supposed to do?'
'Maybe I should just smile and move on.'
Sun Changming smiled and said, "Very good. Now for the next question..."
Next, Sun Changming threw out three more professional questions in a row, revolving around the prognosis of gastrointestinal tumors, chemotherapy resistance, and the anatomical blind spots in lymph node resection.
Jiang He answered fluently.
His answers were based on the existing equipment and drug guidelines of 2008.
Yet at key points, he could also offer a commanding, forward-thinking perspective.
He struck just the right balance.
It gave off the feeling that he was using a cheat, but there was no proof.
Sun Changming grew tired of asking questions and signaled for Wang Xiaoqing to take over.
Wang Xiaoqing said, "Jiang He, your professional expertise is beyond doubt, but today I'd like to ask a question about medical ethics."
"Please, Professor Wang."
"Let's assume you're now an Attending Physician. Your patient has a life expectancy of no more than four months. The patient's family comes to you privately and strongly insists that you hide the patient's condition from them. However, the patient themself is very perceptive and has been repeatedly asking you about their true situation. Faced with the patient's right to know and the family's request for 'protective medical care,' how would you handle this in the current domestic medical environment?"
The conference room fell silent.
In medical ethics, there are no absolute right answers.