I can see the status bar

Chapter 1147 Changes
A truck with a banner of "Song'an Province Helping Yunhe Epidemic" was lying on the expressway, and the carriage behind it had been twisted into a twisted shape under the huge impact—and the instruments loaded in the carriage had already Scattered into countless fragments on the ground.

There was nothing serious about the driver, he was standing next to his car, jumping around while talking on the phone.He didn't care about the few minor injuries on his body, but he jumped up and cried into the phone, "Hurry up, the car is full of life-saving things for Yunhe!"

The news that the logistics vehicle rolled over due to a punctured tire on the way quickly reached Song Wen's ears.Her first reaction was to quickly ask the driver about the situation, "Are you all right?"

"He's fine." Director Han Wenping, who had just passed out a kidney stone, said with a sullen face. "There were a few minor abrasions, but nothing serious. After initial treatment, he was arranged to be quarantined locally."

"It's as long as people are okay." Song Wen breathed a sigh of relief. She put on a relaxed face and smiled at Director Han Wenping, who was gloomy.

Han Wenping sighed, "Masks and protective clothing are easy to handle. Even if they can't be raised in Ningyuan for a while, there are so many medical teams in Yunhe, and they will come here as soon as they ask for their support. The problem is... there is a The instrument is damaged, and I really can’t get this thing in a short time.”

Yes, the car is equipped with the only artificial liver support system in the Fourth Hospital.And this set of precision instruments was dropped into a "factory setting" in this car accident-the parts were paved for two lanes, and if you want to put it back together... you may need to replace all the parts.

This equipment of the Fourth Hospital is different from the general artificial liver support system, it is currently a relatively high-end hybrid artificial liver support system.In addition to the same semi-permeable membrane as the traditional artificial liver, the device is filled with hollow fiber tubes of pig liver cells.Compared with the traditional physical artificial liver system, this hybrid artificial liver has both the detoxification function of the physical artificial liver and the biochemical synthesis and transformation functions of the biological artificial liver.

In addition to the three major disadvantages of equipment efficiency far inferior to real livers, high cost during use, and scarcity of sources of bioreactors, the function of hybrid artificial livers is almost the same as that of real livers.

Back then, with the support of this hybrid artificial liver, Xiao Yanran endured for more than half a year, and then waited for her first liver transplant.

Now... this artificial liver support system, which has made great achievements in the Department of Hepatobiliary Surgery of the Fourth Hospital, has completely become a waste product.The only good news is that the hollow fiber tube of pig liver cells that was packed with it on the car was not damaged because it was packed in a special impact-resistant suitcase.

"All the transported equipment is insured, and we have nothing to lose." Director Han Wenping said helplessly, "The problem is that it is useless to have fiber tubes alone, and it is useless to have more consumables without equipment. "

"Have you contacted the manufacturer?" Song Wen asked with a frown, "It's already the 28th. They should have resumed work, right?"

The hybrid artificial liver support system purchased by the Fourth Hospital is a domestic model. Compared with imported products, the biggest advantage of the domestic model is that it is more convenient for production and after-sales.Although consumables are still difficult to buy, it is always more convenient than importing them from abroad.

"I've already contacted them before I came here." Han Wenping's expression looked a little better, but his brows were still tightly frowned, "The other parts are all in place, the only problem is that the two parts used in the device are The model motor is an imported product, this... is not in stock."

"Let them find a way." Song Wen's expression did not change at all, she said very directly, "Now is a special period, I don't care what they do, at least get out the equipment immediately so that we can use it first-this It's something to save lives!"

Han Wenping had already communicated with the manufacturer of the artificial liver before coming, "They have a proposal, I think it can be considered. They are going to replace it with a domestic motor, but the domestic version of these two types of motors has not been available before. After finalizing the test, in order to prevent problems during use... they will send two artificial liver systems equipped with domestic motors at a time. In this way, if something goes wrong, we will have the second one to replace it first."

"I think it's okay." Song Wen nodded, and then asked, "What if there is something wrong with the second station?"

"The manufacturer of the motor and the artificial liver will send an engineer to station there. If there is a problem with the equipment, they will wear protective clothing and go directly to the red zone for repairs." Han Wenping said, "In short, try to ensure that the equipment here is normal. run."

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When Sun Li'en heard that the artificial liver he had been longing for had been scattered into parts on the road, his heart immediately turned cold.

"Can you deliver two spare ones this afternoon?" Just as my heart sank, another piece of good news came to Sun Lien, "That would be great!"

After explaining the ins and outs of the two devices to Sun Lien on the phone, Han Wenping said seriously, "To put it bluntly, you can only use one device on hand. And because the motor used by this device is different from before, so It is very likely that there will be problems of one kind or another during use."

"It's better than nothing." Sun Li'en said seriously, "I'm going to arrange the medicine now, have the consumables been delivered?"

"The consumables will be delivered to the hospital at noon." Han Wenping replied, "I will notify you as soon as the equipment arrives."

After putting down the phone, Sun Lien stood up excitedly and walked around twice, although the equipment was delivered several days later than expected and was damaged on the way.But he still has something to use in the end, which is a good thing.

"Li'en, are you going to the seminar later?" Sun Li'en was circling happily in the restaurant. Zhou Jun suddenly found Sun Li'en in the restaurant. He came over with a plate and asked, "I heard that this time The main discussion content of the seminar was the autopsy report of patients who died of pneumonia caused by the new coronavirus infection."

"Go." Sun Li'en nodded and said, "You must go and listen to this kind of thing - I really don't know much about the contents of pathology... just take this opportunity to see what the experts say about the diagnosis. clinical judgment of the patient."

Zhou Jun put the plate on the table, "That's just for us to go together. I wonder if this seminar can be finished before I go on duty. If it's too late, remember to take a video of me with your mobile phone and I'll come back Let's see."

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In the end, Zhou Jun still failed to catch up with the seminar.The departure time of the shuttle bus was 15 minutes earlier, and the team of Professor Liu who rushed to the hotel from the previous venue was 10 minutes late.

Sitting in the venue, Sun Lien looked at the anatomical pictures and pathology slide reports displayed by the projector with mixed emotions.

"According to our direct observation, the organ edema caused by the new coronavirus is more serious than that caused by other viruses. Regarding this mechanism, our preliminary research believes that it is ACE2 on vascular endothelial cells that mediates the debronchial Secondary infection and vascular endothelial cell damage." Professor Liu, who was giving a report on the podium, had a hoarse voice, and a series of statuses such as "vocal cord congestion" and "fatigue" were clearly displayed on the status bar.But he still insisted, repeating what he has said three times today, "In addition to increasing the viral load in the lungs, the host immune system will also recognize and attack the highly expressed ACE2 that is related to the virus tuberculosis." endothelial cells. We believe that this is probably one of the reasons why a large number of severe patients with new coronaviruses have an inflammatory storm at the same time."

"This is the follow-up autopsy picture. Let me simplify the content for you." Professor Liu quickly clicked through a few PPTs and said, "This specimen is the lung of the first patient who died of a new type of coronavirus infection pneumonia that we dissected. This The specimen has very obvious inflammatory lesions, and the lungs appear patchy to the naked eye. On the cut surface, it can be seen that there are a lot of viscous secretions overflowing from the alveoli, and there are also fibrous cords."

"The characteristics of this specimen suggest that the new coronavirus mainly causes an inflammatory response characterized by deep airway and alveolar damage. This is also consistent with our clinical experience. At the same time, according to the previous fine-needle aspiration of a group of confirmed patients' lung tissue The report shows that the pathological features of the new coronavirus-infected pneumonia are very similar."

"At present, most of the patients we receive are confirmed patients who died within [-] days of onset." Professor Liu quickly took a bunch of other pathological examinations, and made an emphatic explanation on the clinical work, "

"If you find a patient with pulmonary fibrosis in your clinical work, please upload the patient's course and case to the system after confirming the occurrence of pulmonary fibrosis, and we will conduct further analysis." Before concluding his speech, he said, "The new coronavirus is still a new and unfamiliar disease. The more we study about it, the more likely we will find ways to deal with it and treat it."

Professor Liu's speech was over, but the doctors in the audience couldn't let go of this opportunity, and everyone began to raise their hands to ask questions.Seeing everyone's positive attitude, Sun Li'en suddenly realized why Professor Liu's team was late for half an hour before—it was probably because they were surrounded by doctors who were actively asking questions and couldn't get out?

Sun Lien himself had a question to ask. After Professor Liu had already answered three or four questions, he waited for the microphone and asked, "Professor Liu, does the large amount of alveolar mucus found in the autopsy mean that the patient is simply given oxygen therapy?" Maybe the effect is not good, and we should consider using mucolytic drugs such as ambroxol more actively, and then perform expectoration and bronchial suction?"

"This is definitely more in line with the conclusions obtained from our gross anatomy." Professor Liu nodded and said, "Although the patient has alveolar damage, under the microscope, the degree of alveolar damage is not particularly severe. We must explain the diagnosis of the patient. Severe intractable hypoxemia, then we can only start with mucus blockage."

"ACE2 receptors exist in large quantities in the human body, and they are also expressed in large quantities in the intestinal epithelial tissue." Sun Lien continued to ask, "During this dissection, did the general intestinal tract show pathological changes?"

"The small intestine has segmental dilation and narrowing." Professor Liu nodded, "But the tissue is not seriously damaged under the microscope. It is not yet certain whether the lesion is related to infection or the individual lesion of the patient. Related. The few cases that were dissected later generally did not show gastrointestinal symptoms before their death, and their small intestines looked normal."

"Among the patients we treated, several patients reported changes in their sense of smell." Sun Lien continued to ask, "During the general anatomy you performed, did the patients show central nervous lesions?"

Professor Liu closed the PPT, and then opened a folder.After looking for pictures in it, he opened a picture and said, "From the general appearance of the brain, we can see the symptoms of cerebral edema and mild atrophy of the cerebral cortex. But combined with the clinical data, I It is believed that this general neurological change should have little or nothing to do with infection."

At the same time, Professor Liu opened a case report with the patient's name removed and explained, "The patient himself is old and has multiple cerebral infarctions and sequelae of cerebrovascular disease. At least from the naked eye, I did not find any specific manifestations of infection. As for the abnormal sense of smell you mentioned, whether this means that the virus has invaded the nervous system remains to be verified by histopathology."

Sun Lien's questions are over. To be honest, these questions have not been answered very well.

He has also experienced the alveolar mucus in his previous clinical work. After all, they have washed out tree-shaped sputum plugs mixed with blood under the bronchoscope.In critically ill patients, hypoxemia tends to improve after prone position ventilation.Based on these two points alone, doctors can probably infer that there is a lot of mucus in the alveoli in the patient's body.

The more noteworthy intestinal lesions and central nervous lesions were not directly confirmed in this gross anatomy, which made Sun Lien somewhat helpless.

This has not been directly confirmed, which means that the patient's other organ damage still has two different explanations - viral damage or immune system response damage.Although both are organ injuries, the treatment methods for the injuries caused by the two different mechanisms are completely different.

If it is a viral injury, it means that there is a high probability that there will be live viruses floating in the patient's blood.For such patients, active plasma exchange may have a certain effect.And if it is immune damage, then the use of immunosuppressive regimens should be considered for control.

The content of central neuropathy is more important-nerve damage is often irreversible.If it is determined that the abnormal sense of smell is related to the damage of the central nervous system, it means that the treatment of patients should be more aggressive and advanced.If necessary and resources are available, even general use of convalescent plasma in ordinary patients should be considered to avoid possible neurological damage.

Thinking of this, Sun Li'en couldn't help but sighed, it would be great if there was so much plasma from convalescents on hand that they would not worry about using it at all.If only there were enough people, it would be nice to conduct follow-up surveys on recovered and discharged patients...

The plasma of recovered patients is too much to be used up, so it is natural to consider using it earlier to neutralize the virus and reduce damage.If there are enough people to track the recovered patients, maybe they can find other sequelae of new coronavirus infection related to central nervous system disease.

The questions from other doctors ended after about 10 minutes. Professor Liu stood up unsteadily, and began to pack his things and prepare to leave.And Sun Li'en went to the stage and handed a can of black coffee to this great old man.

"You need to take a good rest." Sun Li'en watched Professor Liu take the coffee and then frowned and said, "Now Yunhe's condition has improved significantly, and we have accumulated a lot of clinical experience. There is less urgency for autopsy reports."

"You have experience, but experience is not everything." Professor Liu shook his head with a smile and said, "We are scientific and technological workers who work under the guidance of science, and we must have something tangible to turn your experience into reality." It's a real plan."

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(End of this chapter)