godfather of surgery

Chapter 1134: Four Different Kinds of People

Luo Jin planned to stay in the hospital for a while. He would receive follow-up treatment until the tumor was completely cleared. Yang Ping also wanted to see as soon as possible whether multiple treatments could kill all the tumor cells.

Volunteers for the Phase II and Phase III clinical trials were originally intended to be recruited from the public, but open recruitment has not yet begun. Many people have called to inquire, but the number of volunteers is limited and can only be allocated to donors who donate to the foundation.

They would rather take risks and give this new method a try. This is determined by people's desire to survive.

The amount of funds in the scientific research foundation is already huge. It can be said that Yang Ping has no shortage of money for any research, and has saved a lot of money for the country.

Because the biological preparations for this new therapy will be produced and sold by Ruixing in the future, many multinational companies are actively negotiating with Ruixing, hoping to start cooperation at that time to avoid falling behind.

Many companies also expressed their desire to invest in Ruixing, but were rejected by Ruixing. Ruixing has no plans to go public or introduce external funds. It only wants to develop step by step on its own.

Huang Jiacai has his own ideas. Once external funds are introduced or the company goes public, there will be potential risks to the control of the company. Moreover, Ruixing is not short of money now. The medical device product matrix has been fully rolled out and the cash flow is very sufficient.

The drug development cycle is long, but he is not afraid. With the cash cow of medical devices, there is no problem in holding on until some new products such as drugs and biological agents come out. Even if it really needs money, many banks will fully support Ruixing, so it does not need any other funds at all.

Besides, Ruixing has the strong support of giants such as Anning Group, Changxin Mining, Guo Group, etc.

The advantages of this K virus therapy gradually emerged. When it was used on Ning Yu, the side effects were very low. He only had a low fever and mild cold-like catarrhal symptoms that day, and he returned to normal the next day. The entire treatment process was very easy, which meant that many of the emergency measures that Yang Ping had originally prepared did not have to be used.

But for safety reasons, Ning Qi still let Ning Yu stay for a few more days. She only had this one younger brother, so no matter how busy she was, she would make time to visit Ning Yu every day.

Yang Ping went to the general surgery department to see Director Fang's patient. On his way back, he received a call from Director Xu of the neurology department.

There is a rather special case in the Department of Neurology. It is an 18-year-old male high school student who has suffered from severe headaches and recurrent epileptic seizures. He has been in the hospital for three days but has not received a diagnosis. Generally, if a diagnosis is not received within three days, it is necessary to consider that this is a difficult and complicated disease.

Yang Ping had no choice but to come to the Department of Neurology. He seldom came to the Department of Internal Medicine. Most of the departments he consulted were the Department of Surgery. Unless there were very special reasons, the Department of Internal Medicine would not ask doctors from the research institute for consultation. After all, the doctors from the research institute were all surgeons.

In terms of diagnostic level, internists have always looked down on surgeons. The two most obvious points that internists look down on surgeons are: medical record writing and diagnostic level.

Internal medicine doctors often think that surgical records are a mess and terrible to read. They are also not very good at diagnosis and they just operate all the time.

But Yang Ping is an exception for them. It is difficult to say whether Yang Ping's current research institute is a surgery department or an internal medicine department. If you say it is a surgery department, they study biological treatment of tumors. If you say it is an internal medicine department, they perform surgery all day long.

As soon as he arrived at the internal medicine ward, all the doctors he met greeted Yang Ping respectfully. They all had serious expressions, as if they were walking and thinking, which was completely different from the brisk and active temperament of the surgeons.

"Professor Yang, thank you for your help."

Director Xu Yaqin of the Department of Neurology is newly appointed. She graduated from the eight-year program of Nandu Medical University and was among the top students in the province in the college entrance examination. She is definitely a top student.

This time, Dean Xia carried out reforms and promoted her to be the department director. The original director stepped down and went to the Overseas Chinese Building to serve as an expert.

"It's not a trouble. I just came to take a look. I may not be able to help, and I'm not very familiar with neurology." Yang Ping was quite polite.

Director Xu was filled with admiration for the fact that he was so humble despite having achieved such great success.

"We have considered the common causes of epilepsy, such as infection, trauma, stroke, etc. We have also conducted tests in this regard, but have not found the cause. We are currently only treating the symptoms."

"His grandfather had a history of epilepsy, so I considered it to be genetic, but after a series of tests, I still couldn't find any evidence."

“Almost all the tests that can be done have been done.”

Director Xu accompanied Yang Ping all the way to the ward, followed by a large group of doctors. That's how it is in a teaching hospital. As soon as the professor shows up, a large group of interns, residents, and graduate students will follow.

The patient was already drowsy and kept complaining of a headache. Yang Ping asked the child's father some questions but found no clues. He personally examined the patient and the symptoms were very similar to those of an intracranial infection, but the results did not match those of a viral or bacterial infection.

"Her grandfather has epilepsy. Is it a genetic factor?" the child's father asked again.

"It can basically be ruled out. We also know his grandfather's genetic pedigree very well. It should be a rare sex-linked Y chromosome inheritance. This situation is impossible to be inherited by him, so we have ruled out hereditary diseases."

Director Xu explained that she specifically found the genetic pedigree chart inserted in the medical records and asked the child's mother again: "Are you sure you remember these sick relatives? Take another look."

"I won't remember it wrong." The child's mother was very sure.

Fortunately, his mother's relatives took photos of the medical records they could find and sent them to her via WeChat, so there is no problem with the genetic pedigree and it is very reliable.

"Look, from the genetic pedigree, this completely conforms to the characteristics of sex-linked Y chromosome inheritance. How could it be inherited by this child?" Director Xu pointed to Yang Ping.

That's true. If there were no errors in the genetic pedigree, the child's grandfather's disease could not have been passed on to his grandson.

Because the male sex chromosome is XY and the female sex chromosome is XX, if the child's mother has a Y chromosome, it means that the disease gene is located on the Y chromosome. The child's mother inherited an X chromosome from her grandfather and an X chromosome from her grandmother, thus forming the female's XX chromosome. The Y chromosome can only be inherited by males and cannot be inherited by females, so the child's mother cannot get the diseased Y chromosome. In this way, the genetic disease line from the child's mother is broken, and there is no disease gene passed on to the child. If it is inherited, it will be passed on to boys from the child's uncle.

If it is a genetic disease, there are only two possibilities. The mother of the child is a rare hermaphrodite with XXY chromosomes, which is extremely rare. Another possibility is that the child is not the mother's biological child. How is this possible? The father may be wrong, but the mother will never be wrong. Of course, theoretically, there are several other possibilities, such as the father of the child is not the biological father, and he got the diseased Y chromosome from the biological father.

It's a bit complicated. These are just Yang Ping's rational and objective speculations, which are purely biological reasonings and have no sociological implications.

"Infection, tumor, trauma, and other factors, we have considered them all," said Director Xu. "Let's go back to the office and I will take a look at the medical records."

Yang Ping has not yet obtained all the medical records and dared not draw any conclusions. He just received a call on the way, so he had no time to review the medical records in advance. During normal consultations, as long as he had time, Yang Ping would definitely review the medical records in advance. This is his habit.

Back in the doctor's office, everyone sat down, surrounded by many doctors. However, Yang Ping was already accustomed to this situation. Although he regarded himself as an ordinary doctor, these students did not think so.

"Does he have a history of wild swimming? In addition to bacterial, viral, and fungal infections, we also need to consider rare parasitic infections."

Yang Ping was just reminding them, but with Xu Yaqin's level, she would not focus her thinking on common and frequently occurring diseases, but would definitely cover all aspects in her thinking.

"For example, we have also considered primary amoebic meningitis. We have repeatedly examined the cerebrospinal fluid and looked for pathogens under a microscope, but no pathogens were found," said Director Xu Yaqin.

Although she is young, she is very steady and experienced and will not make such low-level mistakes. These checks must be fully covered.

"He went swimming in a pond in the wild ten days ago," the medical record read.

This cannot help but remind people of primary amoebic meningitis, also known as Naegleria fowleri. This disease is very rare and has a very high mortality rate if not treated in time. The disease develops rapidly within 5 days after infection and patients generally die within 1-2 weeks. Only 10 survivors have been reported worldwide, with a mortality rate of 97%.

Because this disease is rare, it is difficult to diagnose in time.

Less than 400 cases have been reported worldwide, and the most common infected population is 5-14 years old. Because this protozoa is generally distributed in tropical and subtropical freshwater, such as ponds, lakes, rivers, etc., this disease generally has a history of exposure to wild freshwater. The diagnosis depends on finding pathogens under a cerebrospinal fluid smear microscope.

When water containing this protozoa enters the nasal cavity, it will invade the nerves through the olfactory mucosa in the nasal cavity, invade the central nervous system along the nerve fibers, pass through the cribriform plate along the nerve fibers, reach the olfactory bulb, and cause fibrous purulent meningitis accompanied by brain parenchymal edema, hemorrhage, and necrosis. However, the risk of causing primary amebic meningitis is one in 100 million.

His diagnosis window was only five days, and four days had already passed, so Director Xu was very anxious.

She had considered this disease as the symptoms were very similar, but no pathogen was found in the cerebrospinal fluid several times. This was illogical. If it were, the pathogen would definitely be found.

Headache, vomiting, fatigue, nausea, changes in taste and smell, confusion, hallucinations, epilepsy, ataxia, inattention, etc. These are not specific and can also occur in bacterial and viral meningitis.

And now the main symptom is epilepsy, and there are many diseases that cause epilepsy symptoms.

"If it's this kind of disease, it will be troublesome? We plan to treat him for this most dangerous disease first, and prepare to directly use miltefosine and other antibacterial drugs. What do you think?" Director Xu had a clear idea.

Yang Ping agreed with this opinion. Before a diagnosis is made, if there are multiple possibilities, the most dangerous disease should be treated first. If it is this disease, treatment will not be delayed. If it is not, there will only be the risk of side effects from the drugs.

Compared with saving lives, nothing is more important than drug side effects. Once you get this disease, if you don't take medicine in time, the mortality rate is 97%.

This disease is indeed very strange, it is like this and like that, but there is enough evidence to rule out this and that? It is totally a hodgepodge.

If it was amoebic meningitis, how could there be no pathogen in the cerebrospinal fluid? And after multiple tests, no pathogen was found at all.

If it is some other disease, how could there be no evidence? For example, bacterial or viral infection will also be reflected in the cerebrospinal fluid.

The symptoms seem like infection, but various objective examination results seem like genetic diseases. The genetic pedigree rules out genetic diseases, and etiological examination rules out infection.

Yang Ping had to think about it carefully. He kept looking through the information, especially the genetic pedigree.

"Is this child your biological child?" Yang Ping asked.

Director Xu said: "Yes, I asked that too."

Yang Ping hummed, it was really strange.

"If he was infected, why didn't he have a fever? His family said that he had no fever symptoms at home. The first symptom was a sudden fall to the ground and convulsions, which lasted for two minutes and then he was as good as ever. This is a typical symptom of epilepsy. I heard that his grandfather had this disease, so I naturally thought of the possibility of a genetic disease, but genetic pedigree speculation is simply impossible." said Director Xu.

"Has genetic analysis been done?" Yang Ping asked.

"We didn't do it. It's too late because the genetic lineage has been ruled out. We didn't do genetic analysis." Director Xu said.

Genetic analysis needs to be sent to the genetics laboratory of Nandu Medical University, which takes a long time and is very expensive, and it is impossible to get results in a short time.

"How about this, you guys treat it as amoebic meningitis first, and then do a genetic analysis. Do the genetic analysis while you're doing the experimental treatment."

If there is a loophole in the diagnosis of this case, this is the only loophole, there is no genetic analysis.

However, since there is a genetic pedigree, it can actually be ruled out preliminarily, but ultimately we still have to rely on genetic analysis to determine whether it is a genetic disease.

"Okay, let's do this? Professor Yang, are you worried about the possibility of your child having a genetic disease?" Director Xu said.

Yang Ping nodded: "I would rather believe that it is a genetic disease than to believe that if it is a protozoan infection, there will be no pathogen in the cerebrospinal fluid."

"If no pathogens are found in the cerebrospinal fluid, there are only two possibilities: one is that the density of the pathogens is very low, so how could it cause such serious symptoms? The second possibility is that there is a problem with the circulation of the cerebrospinal fluid, and the pathogens have not entered the cerebrospinal fluid. How is this possible? If there is a problem with the circulation of the cerebrospinal fluid, it would have caused symptoms of circulatory disorders long ago."

The underlying logic of this world is the physical world. There are many people who break the law, but there are no people in this world who violate the laws of physics.