I can see the status bar

Chapter 182 Shadow
In the outpatient room of the rheumatology and immunology department, the popularity is extremely busy today.

Generally, the most popular animal in the zoo is the panda, especially when the panda starts to eat, the tourists in the zoo will gather from all directions, and then hold their mobile phones together, looking at the black, white and white animal in front of them. The big fat man gnaws on apples or special steamed buns.

And today's Rheumatology and Immunology Clinic of the Fourth Central Hospital... It's probably similar to a giant panda standing on one leg and playing skipping rope all the time, and also uttering words, fluently speaking a part of the mouthful part in "Reporting the Name of the Vegetable".

They came to see the excitement, to see a "foreign doctor" in a white coat treating patients.

Speaking of foreign doctors, Bethune must be the first name that pops up in the minds of Chinese people.That great internationalist fighter resolutely came to China, which was in the most difficult period, and stayed here forever. Almost every Chinese knows this story.

With Comrade Bethune as the base, the fair-skinned Dr. Pascal immediately gained the buff of "increased favorability". Because some professional terms need to be explained specially, and at the same time, he needs to use the right to comply with prescriptions and facilitate the understanding of patients, etc., Pascal When the doctor was visiting, the Department of Rheumatology and Immunology specially dispatched a young doctor with excellent English skills to act as an interpreter.

There is an increase in favorability, translation, and Dr. Pascal's American practice of medicine-slowly chatting with patients about the condition, and trying to explain the cause in detail as much as possible.This made Dr. Pascal explode in popularity during the week when the emergency department was closed, and became the most sought after doctor in the outpatient department of the Fourth Central Hospital.

Many people in Ningyuan have heard the news that a foreign doctor with a good attitude and high level came to the Fourth Central Hospital!

Dr. Pascale has been to China many times through MSF's project and often treats patients in China.But in the past, it was more often that he and other doctors formed a treatment team and took the initiative to go to places with inconvenient transportation.Although everyone is very enthusiastic, after all, the number of people in small villages with inconvenient transportation is limited. Even if everyone comes together, it is only a day or two to see all of them.But Ningyuan...is a big city with a population of several million.

Since Sun Li'en and Xu Yourong were isolated and observed, Dr. Pascal started his outpatient life.On the first day, everyone still couldn't figure out his way.There are very few patients who come to see him. Occasionally, there are a few patients who are uncertain or hope to get a second suggestion from other doctors.

The next day, gradually some well-informed patients came to the door.Pascal's level is indeed good, and the treatment plans for these patients are well arranged.But more importantly, he has more time and is used to spending more time seeing patients.There are too many patients that Chinese doctors need to see. Even if the consultation time for each patient is less than 5 minutes, there will still be many people waiting in line.Sometimes it even happens that after the first morning registration, when the outpatient clinic closes in the afternoon, there are still more than a hundred people who have not received treatment.

On the third day, more patients began to choose to visit Professor Pascale's outpatient clinic, and from this day on, Professor Pascale's lunch time began to have the same quantum uncertainty as other doctors.Who knows when I'll find free time!He could only take a bite of the sandwich his wife made by himself while the second patient was about to enter the room after finishing watching the first patient.

Today is the eighth day that Dr. Pascale has been out of the clinic.

Dr. Pascal rubbed his hot head, he felt like he had returned to his college days this week.Every patient is different, and everyone responds differently to treatment.He needs to deal with dozens or hundreds of different patients in one day, and formulate appropriate treatment plans for them.This kind of workload is impossible to finish with his original reception style.As a result, he also began to gradually change his work style, and began to move closer to the Chinese doctors whom he did not agree with before—using the fastest speed and the most direct style to deal with every patient who came to him.

"Consultation?" The translator who was in charge of assisting him raised his eyebrows, turned around and asked, "Old Pa, I would like to invite you to the emergency department..."

"I'll be right there!" Dr. Pascal stood up and rushed towards the emergency room.In all fairness, the old Pa has performed very well.It's just that this kind of endless outpatient clinic really made him feel a little scared.In the name of consultation, even just going out for a walk would be relaxing for him.

"What's this for?" The patient who was still waiting at the door stared curiously at Pascal who was running all the way, "What's wrong with that man inside? Why did you scare the foreign doctor away?"

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"Hmm..." Dr. Pascal looked at Yang Jianqiang's test results, frowned for a long time and then shook his head, "His low CD4 should be mainly due to the effect of immunosuppressants. It's not caused by some unknown disease."

Sun Lien had expected this answer for a long time, and Yang Jianqiang is now doing new CT and MRI.The main reason why he invited Dr. Pascal to come to the consultation is actually to see if there is room for further adjustment of the triple immunosuppressive regimen that Yang Jianqiang is currently using.If the activity of Yang Jianqiang's immune system can be increased within the scope of ensuring the safety of transplanted bone marrow, it is possible to use his own immune system to mark unknown pathogens that cause diseases.

"This... is almost impossible." Dr. Pascal poured cold water on Sun Lien's whimsy, "The reason why such a combined immunosuppressive regimen is used in clinical practice is because the inhibitory effect of a single drug is not ideal. To achieve the goal we want If the level of suppression is required, the dosage of a single drug will become very large. This will undoubtedly increase the chances of organ damage and other side effects in patients. The most important reason for using a combined immune program is through the interaction between the three drugs. It can improve the effect of immunosuppression." He sighed and continued shaking his head, "If the immunosuppressant is reduced or even stopped, I even think that before his immune system recognizes the pathogen you are looking for, Just kill all the bone marrow cells from the allograft. Then cause an inflammatory storm, and finally directly let your patient die of high fever and respiratory failure."

"But the patient's condition has changed." Sun Lien specifically pointed to the column of cerebrospinal fluid pressure level, "His brain pressure was still at a normal level when he was admitted to the hospital to collect cerebrospinal fluid, and after our doctor adjusted his immunization plan, he Suddenly there was a rise in intracranial pressure."

"It might be a side effect caused by the mycophenolate mofetil he used..." Dr. Pascal stopped suddenly, shook his head, and rejected his own idea, "No, even if the lymphoma squeezed the brain, It shouldn't have appeared so soon."

One of the rare side effects of mycophenolate mofetil is the possibility of lymphoma and non-melanoma skin tumors.But Yang Jianqiang only started using mycophenolate mofetil 24 hours ago. Even if he unfortunately suffers from this rare side effect, the symptoms of the disease will not appear on him so quickly.

"His immune system is in a suppressed state, so it will not be an allergic reaction caused by methylprednisolone. Basiliximab will only react with T cells and should not cause problems in the central nervous system." Dr. Pascal The more I pondered, the more confused I became, and I even began to wonder if I had misremembered the side effects of these drugs.

Considered according to normal logic, if the condition A in a system changes, then the result B output by the system also changes.It would then be natural to assume that the change in outcome B was caused by condition A.But according to current knowledge, it is absolutely impossible for a change in condition A to induce such a difference.No wonder Dr. Pascale was confused.It's like adding only salt when cooking, but the dish tastes sweet.

"I'm wondering... is it because after we adjusted his suppression plan, the new suppression plan is not as effective as the previous one." Sun Lien slowly expressed his conjecture, "This made his immune system slightly more active than before. One point. And this point, could it be the reason for the change in symptoms before and after?"

"If your guess is correct..." Dr. Pascal gasped, "then his infection may have reached a serious level."

Emergency CT scan came out.During this inspection, the Imaging Department found eight areas of low-density edema—that is, eight shadows.

"It's definitely not a tumor. It's not bacterial encephalitis." The radiologist agreed with Liu Pingchuan who came for consultation.These eight mildly edematous areas are located relatively close to the ventricles, so they caused relatively obvious changes in cerebrospinal fluid pressure.

"Anyway, this is at least the beginning." Liu Pingchuan patted Sun Li'en on the shoulder, "What do you plan to do with the subsequent diagnosis?"

Sun Lien frowned and thought for a long time, then suddenly asked Dr. Pascal, "Is there any disease that can be transmitted through bone marrow transplantation?"

　Thanks to book friend 160817001020167 for the reward of 100 starting coins.

　　Thanks for the reward of 1100 starting coins from book friend Echinacea.

　　Chapter 10 fixed a bug - nurses do not have the right to do waist puncture.

　　
　
(End of this chapter)