I can see the status bar

Chapter 1146 Choice
Tian Kang's case deserves a New England report.As long as he does benefit from the inflammatory response caused by the infection and the tumor shrinks substantially, this article is not only worthy of a New England article, it may even lead researchers to develop a new treatment for Hodge. Gold Lymphoma Protocol.

But this is not what Sun Lien needs to care about now, at least he doesn’t plan to hide Tian Kang like a big baby right away—Tian Kang is still recovering, and his new coronavirus nucleic acid test has not yet turned negative .

The key now is still to provide antiviral treatment and life support for him and other patients, rather than grabbing Tian Kang, wishing to do hundreds of tests a day to determine what changes in his body caused the tumor to shrink.

"Yang Yifei's condition is progressing, but the speed of progress is not too fast." After listening to everyone's discussion, Sun Lien made a decision, "In this situation, the use of plasma from convalescents is not considered for the time being. It is better to carry out routine antiviral treatment and strengthen the Nutrition and gut microenvironment adjustment."

"Tian Kang's question..." Sun Lien said after pondering for a while, "Normal antiviral treatment, stop his convalescent plasma."

"Stop now?" Dr. Ma Yongfang raised a different opinion, "His lung lesions still exist, and his blood oxygen saturation is not particularly high. Isn't it a bit risky to stop the plasma of convalescents immediately?"

Sun Lien shook his head and said, "There is no fixed amount of plasma from convalescent patients, but there is a consensus that it is certain - if it is useful, the effect will be shown soon."

The main active ingredient in the plasma of convalescents is IgG globulin produced in the human body and capable of rapidly acting against the new coronavirus.This protein is extremely efficient in neutralizing the virus. As long as the titer is sufficient and the virus itself does not undergo mutations that may lead to immune escape, the IgG protein can take effect quickly and then clear a large number of viruses in the human body.

Using convalescent plasma, the greatest uncertainty is the degree of specificity of the IgG protein in the plasma of the donor and the concentration of this specific protein.If the concentration is too low or the degree of specificity is insufficient, it is difficult to meet the requirements of antiviral treatment.

It can be said that before injecting and observing the patient's reaction, no one knows whether the convalescent plasma is useful or not.

What's more, Tian Kang has already accepted 400 ml of plasma donated by a plasma donor who recovered from the new coronavirus. In a short period of time, for the purpose of preventing acute blood transfusion adverse reactions, Tian Kang can no longer accept plasma injections from recovered patients.

Since Tian Kang can no longer receive injections for a short period of time, and Tian Kang has indeed improved—then simply stop the plasma injection of the convalescent.Sun Lien tapped on the table with a pen, explaining his decision, "Now, his infection with the new coronavirus is improving, and this improvement is continuous - we can think that this is the immune system in his body. It works normally. And according to the current observation, this effect seems to have a good effect on his tumor."

"Stopping new plasma injections from convalescents will have limited negative impact on him. At most, the recovery process will be a little slower." Zhou Ce nodded beside him and said, "If it is really the immune system that caused his tumor to shrink... Prolonging the recovery period is tantamount to continuing to stimulate the immune system. This is good for his underlying disease."

Bruen frowned and asked, "I'm not an expert in immunology, nor a researcher in oncology, but... wouldn't continuous stimulation of the immune system lead to the immune storm we've been trying to avoid?"

For this, Dr. Bernard has his own explanation, "There is a theory like this - immune storm, which often occurs in patients with severe infection of a single organ. Sustained severe infection causes a large number of immune cells to proliferate and be activated. But the infected organs are limited, and these immune cells can't find targets to attack, so they may attack other healthy tissues."

"However, this patient has Hodgkin's lymphoma, and it is the kind that metastasizes throughout the body." Yuan Pingan took over the topic and said, "Although I don't know what caused the patient's immune system to finally recognize Hodgkin's lymphoma cells, but when we assume that his immune system recognizes the cancer cells normally ... those swollen lymph nodes filled with tumor cells all over his body became the target of immune cells to attack."

"That is to say..." Xu Yourong thought thoughtfully, "The tumor in his body has instead become a shield to protect him from immune storms?"

Sun Lien was not very interested in Bernard's "hypothesis". "The mediators of the tumor storm are not just those immune cells wandering in the patient's body. The killed tumor cells must have a place to go in the end." It’s okay to swallow up the tumor cells, but if the tumor cells are induced to apoptosis by some immune cells, the cytoplasm released by these tumor cells will kill him soon—we still need to pay more attention to his situation.”

"I think..." Chen Xuerong, who had been listening to everyone talking silently, suddenly said, "Could it be that there is something in the plasma of recovered patients that can kill tumors?"

"Like...the two cases of AIDS that were cured?" Bruen asked with great interest, "I remember that the two cases of AIDS were cured by stem cell therapy, right?"

The two cases mentioned by Brunn are called "London patients" and "Berlin patients". Of course, strictly speaking, they can only be called "long-term remission" rather than "complete cure".

"It's not completely impossible, is it?" Xu Yourong also participated in the discussion, "IgG protein already has an anti-tumor effect, maybe it's because of this that he showed improvement?"

Sun Lien sighed and interrupted the enthusiastic discussion of his colleagues, "If the tumor shrinkage is really caused by the IgG protein, then we should be able to observe the tumor in his body come back soon."

Plasma donors must wait at least 14 days between plasma donations.If the tumor shrinkage was really caused by the plasma donor's IgG protein, Tian Kang's tumor should continue to progress after these specific proteins are exhausted.

According to relevant regulations, if it is not for the purpose of neutralizing the virus, doctors will not be able to use plasma from recovered patients for Tian Kang again.

Judging from Tian Kang's physical condition, there will inevitably be a "result" in the next 14 days.Assuming that what is effective on the tumor is really the recovered plasma donated by this unknown plasma donor... Then there are only two results.Either the virus in his body will come back again—and Tian Kang, who has kidney failure and terminal tumors, is unlikely to resist the past; or his new coronavirus infection has fully recovered, and doctors will no longer be able to use this effective medicine on him. Effective convalescent plasma containing IgG immune protein.

"I wish him good luck." Sun Li'en said helplessly, "Okay, this is the end of the discussion, I'll go to the ward to take a look."

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Although the North Fifth District is a red zone, it is still essentially an inpatient ward.All the jobs in other inpatient wards are indispensable here.

Hu Jia was conducting routine ward rounds with other nurses, while Sun Lien plunged into the makeshift ICU.It is the first time that the temporary ICU has been so "deserted" since its establishment.Except for Tian Kang who grabbed the second bed, there was only one patient who was using ECMO lying on the first bed.

The 55-year-old patient named Yuxin has been using ECMO for ten consecutive days.The ECMO working next to him is the one used by Sister Pan before.

The patient's condition was not ideal. Although the blood oxygen saturation was maintained at 100% with the support of VV ECMO, his jaundice was very heavy.On the one hand, this is due to the mechanical hemolysis and jaundice caused by the continuous use of ECMO for ten days, and on the other hand... it is also because of the sudden outbreak of the hepatitis B virus on his body.

Judging from the prompt on the status bar, Yu Xin has been infected with hepatitis B virus for at least 15 years.And because the previous antiviral treatment was in place, and probably because his own immunity was strong enough, hepatitis B was always occult in him.In addition to showing positive anti-HBc, his other hepatitis B virus markers were negative.

But before entering the Yunhe City Infectious Disease Hospital, Yu Xin received treatment against the new coronavirus infection in other hospitals.His level of inflammatory markers was very high at that time. In order to save his life, the doctors in other hospitals had to give him a large dose of glucocorticoids for immunosuppressive treatment.

Immunosuppressive treatment did save his life, but it also brought about the exacerbation of the new coronavirus infection and the sudden outbreak of acute viral hepatitis that caught the doctors by surprise.

Considering that the continued use of glucocorticoids for immunosuppression may directly lead to infection and kill patients, the hospital quickly contacted the Yunhe Infectious Disease Hospital—the treatment team here can experimentally use tocilizumab for precise inflammatory storm blocking, Sun Li'en has become Yu Xin's last hope.

After being transferred to the hospital, due to the aggravation of pneumonia caused by the new coronavirus, the endotracheal intubation could no longer be maintained at the new blood oxygen saturation.Professor Li Chengping, who received the treatment at that time, made a decisive decision and used ECMO for life support for Yu Xin.Subsequently, Sun Lien also used "compassionate drug use" as the purpose of including Yu Xin, who did not meet the entry requirements, into the treatment group, and then started related treatment.

In addition to the old three - tocilizumab, gamma globulin and CRRT, for the sudden outbreak of viral hepatitis in the new body, Sun Lien also deliberately reduced the new conventional antiviral treatment.Most of the conventional antiviral drugs currently used against novel coronavirus infection are metabolized by the liver.

However, in the case of acute viral hepatitis, any drug metabolized by the liver may directly break through the metabolic capacity of the liver, and finally cause Yu Xin's already precarious liver to completely collapse.

Generally, when treating patients with acute hepatitis caused by hepatitis B and patients with active chronic hepatitis, doctors’ first choice is absolute bed rest, and instructs patients to reduce dietary protein intake and try to maintain calorie and vitamin intake.Reduce the metabolic pressure on the patient's liver, and ultimately support the patient from the acute phase to the quiescent phase under the action of the immune system, and start follow-up treatment.

After the inflammatory storm was stopped by tocilizumab, new treatments fell into a quagmire.Conventional antiviral treatment regimens can aggravate liver damage, and without antiviral drugs, the new coronavirus in his body may increase and rampant.Under the blockade of tocilizumab, the immune level in the new body was low.It is also unknown when his acute hepatitis will turn into a quiescent phase.

Difficult, it is really difficult now.Sun Li'en looked at Yu Xin and wanted to sigh. All the treatments now... have no effect on Xin.Antiviral treatment will increase the burden on the liver, and supportive treatment will lead to mechanical hemolysis, and his condition will only get worse if he prolongs it. Stopping immunosuppression will directly expose him to an immune storm.It seems that no matter what to choose now... Yu Xin's final ending can only be death.It is nothing more than a quick death or a slow death, death from immune storm, liver failure or the new coronavirus.

"The patient's condition is still not good." Just as Sun Lien was sighing, Hu Jia walked into the ward and asked, "Do you have any new ideas?"

"No." Sun Lien shook his head, "His only hope now is the artificial liver that is on the way..."

In view of the patient's condition, Sun Li'en and Lu Zhimin had a three-day meeting, and finally decided to apply for an artificial liver device to the superior for supportive treatment.And according to the hemoglobin situation in the new body, timely whole blood transfusion treatment.

In order to prevent the new blood volume from becoming too high during the blood transfusion treatment, Sun Lien also needs to increase the treatment volume of CRRT.

Most patients with pneumonia caused by the new coronavirus have pulmonary edema.Their intake and output need to be adjusted precisely-for severe and critically ill patients, this adjustment level is calculated in milliliters.

Yu Xin needed a blood transfusion, because the continuous mechanical hemolysis caused by ECMO would continuously damage the red blood cells in his blood and reduce the ability of his blood to transport oxygen.

And Yu Xin also needs to reduce blood volume - if the work intensity of CRRT is not adjusted, the increase in blood volume will quickly aggravate his symptoms of pulmonary edema.This is very detrimental to his recovery.

In addition to blood transfusion, for Yu Xin now, the artificial liver is also a necessary life support equipment.

Not to mention the support of the artificial liver, Yu Xin's liver can finally get some respite and gradually receive antiviral treatment.In terms of his current level of mechanical hemolysis, the artificial liver is also a very useful prop—it can replace the new liver and metabolize a considerable part of the hemoglobin floating in his blood.

But the problem is... now the entire Yunhe does not even have an artificial liver machine that can be borrowed.

The artificial liver support system was originally a newborn device.In Sun Li'en's impression, it seems that the Fourth Hospital purchased two sets.But other hospitals, at least the Yunhe City Infectious Diseases Hospital, did not have such equipment.

When Academician Li led the team to Yunhe for support, he specially brought an artificial liver support system developed by her and her team, but this system is currently providing support treatment for another patient, and there is no way to disassemble it for delivery. Come to the North Fifth District to save Yu Xin's life.

In order to obtain this equipment, Sun Lien not only asked for help from the superior department, but also called Song Wen specifically to ask for the equipment to be transported from Ningyuan.Originally, Sun Lien thought that this set of equipment could arrive at Yunhe at the same time as the fourth batch of medical teams arrived, but to his surprise, because the equipment was too big and heavy, and the fourth batch of medical teams carried too many materials, this set of equipment Subsequent shipments can only be made by ground.

"It stands to reason that we should be here today." Hu Jia stood next to Sun Lien and muttered, "Well, I'll make another phone call to remind you. I think we should be here almost today."

　As usual, because I am embarrassed to include the anti-theft chapter, so... I will fill in 200 words for everyone.

　　
　
(End of this chapter)