I can see the status bar

Chapter 693 Death Penalty (updated on October 10th)
Sun Li'en took Hu Chunbo to the ward.As soon as he entered the ward, Hu Chunbo stopped Cao Zhiquan's invasive medical examination and treatment.

Yes, even the treatment stopped.Hu Chunbo forced the nurse who was about to hang the water to stop the work in an unreasonable and straightforward manner.

If CJD can indeed be diagnosed, it is understandable to stop treatment. As a disease with a 100% mortality rate and a 90% mortality rate within one year after onset, doctors have no weapons to fight against this disease.

But Cao Zhiquan has not been diagnosed yet.

"This patient is highly suspected of CJD. You should take precautions before you come in." Hu Chunbo roughly explained, regardless of whether the nurses heard what he was saying, he walked up to Cao Zhiquan, and picked it up from the cart. A pair of gloves pressed down on Cao Zhiquan's eye sockets.

"I can open my eyes, but there is no other reaction." After all, Hu Chunbo is a professional neurologist, and the nurses walked out of the ward hesitantly. Inactive silence."

"I've already confirmed this." Sun Li'en nodded, and then asked, "Are you sure this is CJD? We haven't checked the 14-3-3 protein yet..."

"Highly suspected, and basically certain." Hu Chunbo interrupted Sun Lien, "Other diseases that can cause akinetic mutism will not progress so quickly."

In Hu Chunbo's view, there are only two possibilities for Cao Zhiquan's disease.Either he is a CJD patient, or Cao Zhiquan has symptoms that are almost identical to CJD, but he still has VGKC (complex antibody-associated limbic encephalitis).

"I understand the truth..." Besides the nurse and Cao Zhiquan, there was Zhou Ce who hadn't left in the ward.He just interrupted the conversation between Hu Chunbo and Sun Lien, "Who can explain to me what CJD is? Also, who is this doctor?"

Hu Chunbo's way of instructing in the ward was so imposing and familiar that the nurses only thought that this was probably a doctor who came from Shennei for consultation, and they put down their work and left after listening to his instructions.But Zhou Ce was very sure that Hu Chunbo was not the fourth hospital's own neurophysician.

A total of 17 doctors from the Department of Neurology of the Fourth Hospital were available for consultation, including one chief physician and two deputy chief physicians.And he knew all [-] of them.

"You don't even know about CJD?" Hu Chunbo glanced at Zhou Ce in surprise, then turned to Sun Lien and asked, "You still recruit such an old Gui Pei?"

"Ahem... that..." Sun Lien knew that Zhou Ce's expression was not very good-looking without looking, and quickly explained, "Dr. Zhou is the attending physician in our treatment team, and he is from the Department of Nephrology."

"Oh, I understand now." Although Hu Chunbo's mouth is faster than his brain sometimes, as long as his brain turns around, he is also very smart.He smiled and explained, "Doctor Zhou, it's normal that you don't know if you have been in the kidney for a long time—CJD is an out-and-out rare disease, with an annual incidence of about [-] per million. However, another A similar disease you should have heard of - VGKC."

Zhou Ce showed a somewhat confused expression. After thinking for a while, he shook his head and said, "I haven't heard much about this."

Hu Chunbo was stunned for a moment, and then smiled wryly, "I only thought that VGKC was related to immunity, but I forgot that there are not too many reports of this disease at present."

VGKC is a rare immune-related limbic encephalitis, and most patients show the same MRI image as CJD-ribbon sign.And there are also symptoms of triphasic EEG and subacute dementia consistent with CJD patients.Even the symptoms of a positive 14-3-3 protein in the cerebrospinal fluid are exactly the same.

It can be said that VGKC and CJD are almost identical twins in appearance.But there is still a huge difference between them.

VGKC is treatable.

As one of the autoimmune diseases, VGKC patients can often achieve quite good therapeutic effects after receiving hormone shock therapy and plasma exchange.After regularly taking related glucocorticoid drugs, many VGKC patients can even recover to a completely acceptable level.

But CJD is different. All patients suffering from CJD will die without exception. The mortality rate of CJD patients within one year after onset is as high as 90%, and the longest survival period of CJD patients confirmed in human history is only eight years.

"CJD is Creutzfeldt-Jakob disease." Hu Chunbo did not continue to speak, but Sun Li'en stood up and was responsible for explaining to Zhou Ce what CJD was. "If this name still sounds a little strange, then you must have heard of a special type of it—mad cow disease."

Creutzfeldt-Jakob disease is a fatal infectious disease caused by prion protein particles (prion).At the same time, it is also a zoonotic disease.The most representative of these is the mad cow disease that originated in the British industrialized cattle farms in the 80s.

As a new pathogenic body that was discovered in the last 60 years, prions are different from any pathogenic body that people have traditionally recognized—it does not contain any DNA or RNA structures. The essence of prions is actually A protein particle.However, because prions have not been discovered for too long, and their size is smaller than the smallest known virus (about 30-50 nanometers), human beings' understanding of prions is still very superficial.

Although little is known about the protein particles, doctors and scientists have identified a signature of at least one class of prions.

PrPsc prion virus mainly attacks the nervous system of animals. Prion protein can infect cranial nerves and prompt a large number of nerve cells to die.The death of these nerve cells often leaves a large number of cavities in the brain tissue, making the brain tissue look like a sponge.Therefore, prion diseases are also called transmissible spongiform encephalopathy (TSEs).These include mad cow disease (BSE), which affects cattle and humans, scrapie, which affects sheep and mice, and kuru and Creutzfeldt-Jakob diseases, which are transmissible and even inherited between humans.

Zhou Ce suddenly realized and shook his head again, "This shouldn't be... The patient himself works on the construction site, he must have never been to the UK, let alone eat British beef in China - this stuff should be banned in China of."

"The import ban on British beef was lifted in June 19. And this is not necessarily mad cow disease... He may also be a genetic, sporadic or iatrogenic Creutzfeldt-Jakob disease patient." For Zhou Ce Hu Chunbo gave a very complete answer to the question, and then he began to verify his guess by asking Sun Lien, "Has the patient ever had neurosurgery? Has he ever had a cornea transplant? Have his parents ever suffered from dementia?" Performance?"

"No." Sun Lien shook his head. He had asked the patient's family members about these questions.However, there may be some problems in genetics-Cao Zhiquan's father died on the battlefield to resist US aggression and aid Korea, while his mother died of liver cancer.Needless to say, Cao Zhiquan's father, his mother was less than 50 years old when she passed away.

"That's troublesome." Hu Chunbo sighed, "If it's not hereditary or iatrogenic, then it's sporadic."

The diagnosis of sporadic CJD... is actually kind of funny, strictly speaking.

First of all, there is one and only one diagnostic option for Creutzfeldt-Jakob disease, which is brain tissue biopsy or brain tissue autopsy.In general, unless the spongy brain is seen under a microscope, doctors can only be "highly suspicious" rather than "diagnosed" CJD.

Second, sporadic CJD is Creutzfeldt-Jakob disease with no source at all and no clues at all.No one knows how the patients themselves were infected with prions—some patients had changes in their own genetic loci, so the PrPsc virus was erroneously synthesized in the brain tissue.Some patients had no locus changes at all, but they still showed symptoms of CJD and died quickly.However, due to the willingness of the patient's family members, the possibility of performing brain tissue biopsy or autopsy on patients with highly suspected CJD in China is very small.In more than ten years of statistics, there are only two "highly suspected CJD patients" who underwent autopsy and were finally diagnosed.

It is precisely because of this special phenomenon that doctors will treat "highly suspected" as "diagnosed" of CJD in clinical practice.

No way, the conditions for diagnosis are too harsh.

From a certain point of view, doctors themselves do not want to fully diagnose CJD patients.The reason is also very simple, this disease is incurable.

The characteristics of prions determine that they are immune to all drugs.None of the treatments stopped the virus from replicating itself and killing other nerve cells in the patient's brain.Even radiation has no effect-in fact, it is precisely because of this that humans can confirm that the virus itself does not contain genetic material such as DNA and RNA.Early scientists irradiated the brains of scrapie-affected sheep and then inoculated them again into other healthy sheep.The vaccinated sheep also began to get sick, which led to the bold speculation that "the pathogen does not contain genetic material".

Chemical drugs are ineffective, biological drugs are ineffective, radiation and other methods are ineffective, and more traditional neurosurgery is even less effective—protein particles with a size of less than 50 nanometers, even if the nanorobots in science fiction are really developed , I am afraid it may not be able to handle it.

Taking a step back, even if there are suddenly drugs and treatments that can prevent prions from continuing to replicate.Cao Zhiquan's condition will not improve in the slightest, at most it will stop progressing.Nerve cells that have died cannot be regenerated.

In order to cure CJD patients, it is necessary to have a method that can completely kill the virus and at the same time have the ability to promote nerve cell regeneration.

In other words, it is possible to save Cao Zhiquan's life only if at least two Nobel Prizes in Medicine come together.

Sun Li'en was silent for a while, looked at Cao Zhiquan who was lying on the bed, and shook his head slightly.

(End of this chapter)