I can see the status bar

Chapter 526
Although Sun Lien is only a doctor trained in the emergency department, after more than half a year of dean Wu's special practice, his mastery of various diseases has far surpassed the level of the same year's standard trained doctor.If you don't compare with the top hospitals in China, Sun Lien's professional level can basically be on par with the attending doctors with low seniority.If you only look at the diagnostic ability, especially when it comes to critical illnesses and non-genetic rare diseases, then Sun Lien can even compare with some junior deputy chief physicians.

At least Xu Yourong, who is the deputy chief physician, is far inferior to Sun Lien in terms of diagnosis.

Dr. Pascal fell silent after listening to Sun Lien's opinion. He had no doubts about Sun Lien's personal ability.But this set of diagnostic content is really a bit... appalling.

Myelin oligodendrocyte glycoprotein (MOG) antibody disease is an idiopathic inflammatory demyelinating disease (IIDDs) mediated by MOG antibody.

The incidence of MOG antibody disease is not too much, but it is definitely not up to the standard of rare disease.Although it is a disease whose pathogenesis is not yet clear, as a type of immune system disease, its basic principle is not much different from other immune system diseases that cause nervous system damage-due to some kind of error, the immune system error It marks a portion of nerve cells as an antigen and organizes immune cells to attack it.The result of the attack is an inflammatory response in the nervous system that manifests itself as damage.

As a disease with no specific symptoms (except for conus medullaris involvement), MOG antibody disease is rarely used as the first echelon target of diagnosis.Unless doctors have exhausted their means to rule out other diseases that can cause symptoms.It is first necessary to determine whether the patient is a demyelinating lesion, and then consider whether the lesion is hereditary or acquired—and then judge whether it is a primary demyelinating lesion or a secondary demyelinating lesion.All in all, considering MOG antibody disease means that after at least three rounds of screening, it is clear that the patient is a primary acquired demyelinating lesion.

To diagnose MOG antibody disease, the core gold standard is the detection of MOG antibody itself—MOG-IgG seropositive detected by a cell-based assay using full-length human MOG as the target antigen is the diagnosis of MOG antibody disease. decisive evidence.

Sun Lien obviously did not have this evidence in hand - it took only two hours for the patient to be transferred to the fourth hospital, even if the person started blood collection for testing as soon as he arrived at the hospital, two hours is not enough for the laboratory to conduct a MOG-IgG serum test .

This made Dr. Pascal a little embarrassed. Modern medicine requires evidence-based treatment.But Sun Lien's diagnostic performance is so excellent that Dr. Pascal is a little confused about his diagnostic thinking, let alone directly judge whether Sun Lien's diagnosis is convincing or not—he even can't figure out what the logic of Sun Lien's diagnosis is. What is the problem.

"Look, I know you're a genius in diagnosis." Dr. Pascal was silent for a while, then rubbed his head and said to Sun Li'en, "But you also have to understand the difficulties of an ordinary doctor like me—— Just from your description, I really can’t see where the basis of this diagnosis is. Let’s put it this way, why don’t you explain to me why you link the patient’s optic neuritis three years ago with the current epilepsy .”

Sun Lien was stunned by this question.After combining the nervous system disease three years ago with the current neurological disease, it can be judged that Shen Qiushi's disease is MOG antibody disease.It's a smooth logic, but the rationale for merging the two together...isn't strong enough.

Sun Lien thought about it for a while, and decided to speak frankly, "The reason for linking the previous disease with epilepsy is because the doctors in the Second Hospital did not have this medical history record. The patient was hospitalized in the Second Hospital for more than a week. The patient's epilepsy has undergone multiple medication adjustments, but the onset of the disease still has not improved. Moreover, the patient's limb numbness and progression are also consistent with the symptoms of demyelinating disease-if you want to link demyelinating disease and epilepsy, then you must Consider the optic neuritis three years ago into this system. After all, the rate of progression of his disease does not meet the characteristics of a secondary demyelinating disease."

"That is to say, you put optic neuritis and his current situation together, just because it is more logical?" Dr. Pascal looked at Sun Lien calmly, shook his head and said, "Your judgment may be right, say To be honest, I also think this is more likely. But until I have stronger evidence, I cannot approve your treatment plan."

"After you have a clear direction of suspicion, what you should do is not to come to me immediately and tell me your treatment plan. Instead, conduct relevant tests immediately, and discuss the content of treatment after you get solid evidence " Dr. Pascal sighed, "Even if the antibody test takes more than eight hours, then you can always do a visual evoked potential diagnosis in advance, right?"

Sun Li'en nodded. He really didn't want to understand this. Of course, he hasn't mentioned the more important purpose, "I think, since this patient is likely to be an autoimmune disease, it's best to leave it to you... ..."

"Okay." Dr. Pascal nodded, and then said seriously, "I'll take over after you diagnose his MOG antibody disease."

Sun Li'en blinked, "Old Pa, you have learned badly from Senior Brother Zhou?"

"This is what Qian Hongjun taught me." Pascal laughed out loud. He followed Qian Hongjun's example and scolded, "Hurry up and work, or I will deduct your performance!"

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Lao Pa came to the Fourth Hospital for more than half a year, and was finally brought into the ditch smoothly by the directors of the Fourth Hospital.In the past, when there were cases that needed to be handed over to him, this short old man was very willing to take over the patients and conduct relevant diagnosis and treatment.But now... Sun Li'en wiped away the tears that didn't exist on his face with some grief and indignation, and complained to Xu Yourong, "He actually learned to shirk!"

"Isn't this pretty good?" Xu Yourong's expression remained the same, and the visual evoked potential test was one of the most commonly used diagnostic tests.This kind of experiment can record potential changes in the visual cortex or the occipital area outside the skull through specific visual stimuli.It is an important means to study human sensory function, nervous system diseases, behavior and psychological activities.Sun Lien had never been in contact with this kind of equipment before, so Xu Yourong came with him to see the test results.As for the one who actually started the inspection, it was Sun Lien's college roommate Feng Ming.

"The director of the department does not rush to the frontline clinic, there are advantages and disadvantages." Feng Ming also participated in the conversation between the two.Since getting the certificate with Qin Ya, this kid has grown fat like blowing up a balloon.Moreover, there was always that happy smile on his face that made people want to beat him up anytime and anywhere.Especially after Xu Yourong completed Qin Ya's cerebral artery bypass surgery, this physiologically disgusting smile appeared more frequently.Of course, this may just be the illusion of Sun Lien who was forced to be "pseudo-single". "On the bright side, at least the director won't come to snatch your papers—Director Pa doesn't seem to have any pressure on the papers, does he?"

"Why not?" Sun Li'en and Feng Ming were chatting nonchalantly, "He manages such a large laboratory now, and the academic pressure is definitely greater than that of other department directors."

"I think it may be that Dr. Pascal can't keep up with your thinking." Xu Yourong interjected, "There are too many faults and jumps in your diagnosis. If you want to thoroughly understand every jump It’s really a bit too labor-intensive and the reason why the fault appeared—it’s even a little embarrassing.” She glanced at Sun Li’en, “I still don’t understand why you can connect his optic neuritis with MOG.”

Feng Ming asked with a smile, "Then Dr. Xu, aren't you afraid of losing face if you ask me that?"

"I paid the tuition." Xu Yourong said seriously, "If you don't ask for fear of losing face, wouldn't the tuition you have paid be wasted?"

"It's true..." Feng Ming suddenly interrupted the chat without warning, "Huh?"

"The result?" Sun Li'en became energetic when he heard the news, "What's going on?"

Feng Ming pointed to the screen and said, "The P100 latency of the right eye is a bit long, and the waveform is not quite right..." He squinted his eyes and looked at the results carefully, "The latency of the right eye is 128ms, and the left eye is a normal 100ms. And you can see that the voltage of this potential is also very low...it is only 2.5 microvolts."

"I don't understand, just tell the conclusion." Sun Lien said with a blank expression, "Can you prove that there is a problem?"

"There must be something wrong." Xu Yourong nodded, "Combined with the results of the MRI examination, the possibility of MOG antibody disease is very high."

Sun Lien stood up and stretched, "That's good." He shook his neck, "I'll get Xiao Guo to draw blood, and I'll draw his blood for a serum test when I get back. After confirming the diagnosis, Hand over the patient to Old Pa—I don't believe he can be lazy anymore."

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"Now that the test is clear, let's follow the treatment process you said." Dr. Pascal raised his head in the midst of his busy schedule, and glanced at the visual evoked potential test report brought by Sun Lien, "Well, it's better to add A serum test would be better."

"The serum test is already being done." Sun Lien's eyes widened. "This is different from what was agreed. Didn't you say that you will take over after the diagnosis?"

"There are only a few treatment options for MOG antibody disease, as you have said before." Dr. Pascal lowered his head and continued flipping through the pile of documents in front of him. After a long while, he said "Aha!" and pulled out a few pieces of copy paper , pulled down his glasses and carefully looked at the content printed on it, then nodded in satisfaction. "First use methylprednisolone for shock therapy, supplemented by gamma globulin injection - if the effect is not good, then consider plasma exchange and immunoadsorption therapy. Didn't you make it clear?"

"But..." Sun Lien wanted to say something, but Dr. Pascal stood up directly, "I'll go and see Todd, I have a meeting tonight." He smiled meaningfully at Sun Lien, " As long as you have sufficient diagnostic evidence, let it go. You have to get used to being separated from the leadership of the superior doctor-I think you used to be a good habit."

(End of this chapter)