I can see the status bar

Chapter 747

For the first time, the diagnosis team of Zhou Xiufang Comprehensive Diagnostic Center held a general consultation with all doctors in the department.The purpose of the consultation is very simple, all doctors discuss only one thing - the diagnosis of insufficient expression of AQP4 protein.

For the doctors in the first diagnostic group, insufficient AQP4 protein expression was no longer a problem.Especially after getting the corroboration of the data from the cooperating pathology department.Tang Min's brain white matter biopsy samples did show obvious insufficient expression of AQP4 protein mRNA.Her protein expression is about one-fifth of normal people.

There is already strong evidence to prove that the next issue that should be considered is treatment and intervention, instead of continuing to entangle whether Sun Lien's diagnosis is correct or not.In fact, most of the doctors who have worked with Sun Lien for a long time would not consider challenging Sun Lien's diagnosis.Numerous facts have proved that as long as Sun Lien has confirmed the diagnosis, there is basically no second possibility.History has proved that Sun Lien's diagnosis accuracy rate is as high as 100%.

The second diagnostic group, especially Professor Zhang Zhifu, hoped to discuss a result that everyone could accept.It's not that they think Sun Lien's diagnosis is unreliable.Professor Zhang's direct goal is actually to hope that the doctors in the diagnostic team he leads can extract some valuable knowledge related to diagnostic work from Sun Li'en in this discussion.

To learn knowledge, especially to squeeze knowledge, the most important means and process is to ask questions.From the perspective of the other doctors in the first group, the questions of the colleagues in the second group seemed a little...unfriendly.Sometimes the questions can even be called aggressive.

"I still don't understand." The 29-year-old deputy senior doctor Ma Yongfang shook his head at Sun Lien, "How did you come to this conclusion."

"Just like what I said just now." Sun Li'en shook his head helplessly. He really didn't rely on the status bar for this diagnosis.Conduct a comprehensive inspection, this is the tone set by Sun Lien from the very beginning.He fully considered the gap between the comprehensive capabilities of the Fourth Hospital and Yunhe Hospital and Tongxie, so he decided to do his best from the beginning.In order to appease the emotions of his family members, he chose to use mannitol to treat Tang Min's symptoms.But I didn't expect that the mannitol directly aggravated the size of the low signal area.

Coupled with Dr. Pascal's interpretation of MRI low signal shadows as "edema" rather than "space-occupying lesions", and Yuan Ping'an's extensive reading of literature, the scope of suspects gradually changed from "tumors, genetic diseases, self- Diseases of the immune system" narrowed down to the AQP4 protein step by step.

In the eyes of Sun Li'en and other parties, this whole diagnosis process is not surprising at all.The relationship is clear, the facts are clear, the logic is smooth - what else can't be understood?

But in the eyes of Ma Yongfang and others... this diagnosis is simply a collection of all the incredible things in the world.What they can't understand the most is the jump from "neuromyelitis optica spectrum disorder" to "underexpression of AQP4 protein".

"There are also NMOs that are negative for AQP4 protein antibodies, and the diagnosis needs to be differentiated from multiple sclerosis..."

"Enough." Professor Zhang Zhifu knocked on the table, and then began to criticize the doctors he brought with him, "Look, what stupid questions I'm asking!"

Compared with other doctors in the second group, Professor Zhang himself was quite touched by Sun Lien's leaping diagnosis thinking, "Why don't you go to NMO to identify it? Because it is not NMO!"

"What is the diagnostic standard required by the NMO?" Professor Zhang Zhifu knocked on the table and lectured in the tone of teaching ignorant students, "The patient only has one change similar to optic neuritis. She is not positive for antibodies and does not have myelitis. No recurrent seizures, no spinal cord shadow across the three vertebrae - then she is not NMO!"

"The differential diagnosis of NMO is only about 80% specific. Even without these symptoms, the possibility of NMO cannot be completely denied." If you don't understand, you don't understand. If you don't ask questions because you are worried that the teacher will be angry, this is not the correct attitude for learning .Ma Guofang tried to reason, "Why did Dr. Sun dare to rule out the 20% possibility and instead think about whether this disease is a new disease that has not been discovered at all?"

"This question...let me answer it." Sun Li'en interrupted Professor Zhang Zhifu who was about to continue his attack.If you continue to make Lao Zhang go crazy, he can save a lot of trouble.But the atmosphere in the meeting room is really uncomfortable - if it goes on like this, maybe the doctors in the second group will really hate it for a while.

"The reason why I dare to make this assumption is actually very simple. Because I believe and confirm that Tongxie is one of the best tertiary hospitals in China." Sun Lien explained earnestly, "They have very good doctors, and I also work with them. He has cooperated with the doctors of the Association many times..." At this point, he glanced at Yuan Pingan who was sitting aside and continued, "The diagnostic specificity under the current standard of NMO is about 80%, and they must have considered it. Therefore, I will discuss other possibilities with the doctors in the group after NMO has been ruled out with a probability of about 80%."

This method of explanation is actually somewhat rogue.But in Sun Lien's view, this may be the only reason that can convince Ma Yongfang and others.

After all, telling the truth directly, they find it unbelievable, don't they?
In fact, Sun Li'en didn't think it was inappropriate to question Ma Yongfang and others.The reason is quite simple...it's a matter of mentality.

Although the doctors in the second group are the same as the doctors in the first group, they are not specialized in diagnosis.But they are still a little less than a group...they have dealt with too few intractable diseases.

Of course, normal doctors do not deal with diseases with strange symptoms all day long.But the Comprehensive Diagnostic Center is different.As a department that focuses on the diagnosis of difficult and miscellaneous diseases, they should be mentally prepared that "the diseases I see should not be as simple as the surface state".

Mental preparation is a wonderful thing. At least in Sun Lien’s opinion, it is because the doctors in the second group do not have this kind of identification that they stick to a single diagnostic criterion, instead of keeping open on this basis. Eyes to explore all possibilities.

After a while, the discussion was considered to have completed the first topic.Then, more important content came.

Can Tang Min be experimentally treated with arginine vasopressin?
"First of all, this must be regarded as an over-the-range drug." Regarding the application of arginine vasopressin, the doctors in the two treatment groups basically had no objection.After all, compared with phorbol, arginine vasopressin is still a drug.After a little discussion, Professor Zhang put forward his own opinion, "However, since it is a drug for children, and it still needs to treat a brand-new genetic disease that has not been discovered... I think we should consider the ethics. Audit Committee?"

(End of this chapter)