I can see the status bar

Chapter 743 Diagnostic Results
This is a shocking discovery.Sun Li'en was stunned for a long time without speaking, his mind was full of Liu Tangchun's original sentence "It's just a bag of mannitol..."

That's all?If there is a time machine, Sun Li'en will definitely travel back to two days ago, and then slap himself hard on the face.Mannitol is your illegitimate child?Why do you always feel that you owe it?Do you have to use it?
In all fairness, Sun Lien certainly did not foresee that mannitol would have adverse effects on Tang Min's condition.It would have been impossible for any doctor to have foreseen this.But...if he could be more cautious in dealing with the disease, maybe he wouldn't use mannitol on Tang Min's body.

Sun Lien was busy condemning himself for not being cautious enough in his heart, while Zhou Ce frowned and asked Yuan Pingan, "You mean, the AQP4 protein was inhibited, which led to the progress of her condition?"

"This is a possible inference." Yuan Ping'an also seemed very cautious on this issue, "However... I have never heard that the inhibition of AQP4 protein can cause disease..."

"Then according to this 'possible inference'..." Zhou Ce emphasized the pronunciation of the five words "possible inference", "Can we think that the many low signal areas in her brain are caused by AQP4 being blocked? Caused by suppression?"

Yuan Pingan thought and thought, and finally shook his head, "I can't say for sure."

AQP4 protein is a highly sensitive aquaporin, and its role is not just to pump water molecules into glial cells.It is also able to pump out the water molecules inside the glial cells.From the analysis of this mechanism, the conclusion of the paper itself seems to be somewhat contradictory to the reality - after mannitol passes through the brain-blood barrier, it creates an osmotic gradient in the brain, thereby promoting the water in neurons and glial cells. Molecules enter blood vessels.

But if mannitol can inhibit the expression of AQP4 protein... then what is going on with the expanded low signal shadow?After using the osmotic gradient to pump water molecules from the cells and inhibiting aquaporins, the scope of edema is expanded instead?
"The AQP4 protein not only pumps water molecules into the interstitial cells during the acute phase of cerebral edema, but also slowly pumps out water molecules after the acute phase—you can understand this process as peak regulation of many reservoirs when a heavy rain comes. Water." Yuan Pingan explained Zhou Ce's question in the simplest way and said, "AQP4 is the gate to quickly store water in the reservoir, and the interstitial cells are the reservoir itself-mannitol acts more like a reservoir The water itself evaporates, but at a rate that is many times stronger than pure solar radiation."

This metaphor is easier to understand.Sun Lien frowned and said, "So...after the reservoir evaporated quickly, the water level rose instead?"

"It's not in line with intuitive logic, but it is in line with the status quo." Yuan Ping'an nodded. "If only the reservoir is considered, then after all other possibilities are ruled out, the change can only be caused by the upstream water."

Sun Li'en was planning to continue on this issue, but... it seemed that because of Zhou Ce's words against Brunn, a strange idea suddenly popped up in his mind.

"How can you be sure that we have listed all the possibilities?" He asked back with an arguing mentality, "It can't be other problems?"

"Other questions can't explain the reason for the rising water level." Yuan Ping'an gave Sun Li'en a strange look, as if the questioner was not the deputy head of his own diagnosis team, but a poor child with congenital stupidity. "Other factors can't create water molecules out of thin air, can they?"

"There is an idiom called 'open source and reduce expenditure'." Sun Lien shook his head and said, "Water coming from the upper reaches, this counts as increasing revenue. What if there is a problem with reducing expenditure?"

"You mean..." Yuan Ping'an said hesitantly, but Sun Li'en hurried ahead of him and added, "What if this reservoir...has no gates from the beginning?"

"She didn't have any problems after the AQP4 protein was suppressed, she was born with insufficient expression of AQP4 protein!" At this point, Sun Lien finally made his own diagnosis for the first time. Although there is not enough evidence, he still has Intuitively, this possibility is very high, "That's why mannitol caused such obvious changes!"

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Tang Min's condition can be said to be very complicated, but if the concept of insufficient expression of AQP4 protein is introduced, all problems suddenly have a common solution.

Why was her vision loss the first symptom?Because the AQP4 protein is distributed most in the optic nerve, and the sensitivity of the optic nerve to the interstitium and synapses is also the highest. The expression of AQP4 protein is insufficient, and the water content in the optic nerve rises rapidly, so the symptoms appear.

Why did she later develop uncorrectable hydrocephalus?Because of insufficient AQP4 protein expression, interstitial cells in the brain have difficulty regulating water levels.However, due to the large number of members of the AQP protein family, other AQP proteins compensate the effect of AQP4 protein to a certain extent.Therefore, only refractory hydrocephalus and slight microscopic interstitial cell edema appeared.

Why did her other neurological functions not suffer much after developing hydrocephalus?Because of the low expression of AQP4 protein, the occurrence of cytotoxic edema is restrained instead-the interstitial cells cannot play the role of water storage, and other nerves cannot receive excess water.So she had a herniated brain, but not much neurological damage.But at the same time, she also developed unexplained, persistent increases in intracranial pressure.

At the same time, the lack of AQP4 protein expression can even explain the reason for the current "exacerbation of symptoms after using mannitol".

Before the use of mannitol, the osmotic pressure of cerebrospinal fluid and plasma in the human body was exactly the same.After using mannitol, the plasma osmotic pressure in the human body will rise rapidly, thus forming a physical phenomenon in which the cerebrospinal fluid (brain tissue) transfers water to the plasma.And this phenomenon often rebounds rapidly after stopping the use of mannitol—the plasma osmotic pressure quickly returns to its original value after stopping the use of mannitol, while the osmotic pressure of the cerebrospinal fluid will inevitably increase due to dehydration.Sometimes there is even a reverse osmotic pressure gradient in which the osmotic pressure of the CSF is greater than that of the plasma.

Since mannitol inhibits the expression of AQP4 protein, and Tang Min herself is under the condition of insufficient expression of AQP4 protein, her body cannot balance the pressure difference between cerebrospinal fluid and plasma through this specific water channel system.This led to the status quo of "enlargement of intracranial edema area after the use of mannitol".

"So... these low signal areas are indeed edema. And Tang Min's problem is not a tumor or autoimmune disease. There is something wrong with her gene." Sun Lien concluded, "She is not completely unable to produce AQP4 protein, but It’s the body not producing enough AQP4 protein. That’s why this problem occurs—it boils down to a chronic, irreversible edema of the interstitial cells.”

　The results of Tang Min's case will be released today, and an explanation chapter will be released later—maybe a little later.

　　
　
(End of this chapter)