I Can See Health

  Chapter 845 Amazing speeches around the world (big chapter, ask for votes)

   At this time, more than 200 people had gathered in the conference hall where Mayo was discussing cases.

   Some of them are local Mayo doctors, and the other are foreign visitors.

   Yu Weiguang had nothing to do in the afternoon, so he came too.

  Lu Chen and Yu Weiguang found a front seat and sat down.

   "Lu Chen, I heard that Mayo's quarterly case discussions are broadcast live around the world!" Yu Weiguang looked back at the "long guns and short guns" at the back of the venue.

   "At this point in time, it should be late at night in China, right?" Lu Chen wondered.

"Don't say it, as far as I know, the Kyoto side will organize doctors to watch the replay the next day." Yu Weiguang said, "Today's case routine is more than one, involving many disciplines, not only cardiology. , and some cases of surgical simulation.”

  Lu Chen knew it in his heart.

   No wonder Mayo attaches so much importance to this case discussion, which is already equivalent to a small medical forum.

  Mayo is also a big spender, holding this kind of meeting every quarter.

   It can only be said that Mayo is really rich, and they have encountered a lot of difficult cases, and they are fully capable of hosting this kind of case discussion conference.

   "Look, that's Mayo's current CEO!" Yu Weiguang suddenly motioned to Lu Chen to look at the stage.

   On the rostrum, a middle-aged man with gold-rimmed glasses came up.

   "He's Mayo's boss?" Lu Chen wondered.

   But what is the boss doing in this academic conference?

"He is also a doctor!" Yu Weiguang whispered, "Mayo's CEO rotates every five years and is selected from clinicians. Therefore, Mayo will fully consider when formulating various policies. Doctors will not make such a hot-headed decision."

   "That's pretty good." Lu Chen still appreciates Mayo's management method.

   Unlike the leadership of some hospitals, there is no layman in the medical profession at all.

   So what good policies can you expect these people to come up with?

   In other words, these policies are completely divorced from clinical practice.

   "Lu Chen, I'm really moved now. If possible, I would like to join you in applying for the Mayo Fellow." Yu Weiguang sighed.

   After feeling this pure medical environment, it is difficult for anyone to leave.

   However, although Mayo's medical treatment, the medical expenses are huge!

  The average person simply cannot afford the medical expenses.

  …

   With a speech from the CEO of Mayo, the quarterly case discussion begins.

  Although there are synchronous live broadcasts by major media around the world, Mayo will not talk about most of the etiquette.

   Without any hesitation, he directly brought up the difficult cases.

   is similar to the previous procedure. First, there is a doctor on the tube bed and the condition is reported.

   Then ask questions, and experts will answer them. Finally, it’s time for free questions and answers.

   "Case discussion begins."

   Yu Weiguang whispered.

  Lu Chen also devoted his attention to the huge projection screen at the venue.

   The first case.

   Patient is a 49-year-old female.

   Referred to Mayo Hospital for “4 years of hyperkalemia.”

   He had a history of obesity and was treated with gastric banding.

   In addition, the patient has fibromyalgia and bipolar disorder.

   Four years ago, the patient underwent left kidney and adrenalectomy for unilateral localized renal cell carcinoma.

   Before surgery, serum potassium and blood pressure were normal.

   A few months after the operation, the patient began to feel malaise and had mild episodic headaches.

   went to the local hospital, and the examination showed that he was in a state of hypotension and hyperkalemia (serum potassium 6.8mmol/L).

   After the presentation of the case, the doctor in charge of the bed asked three questions.

   "First, why is the patient persistent hyperkalemia?"

   "Second, what is the diagnosis of this patient?"

   "Third, what is the next treatment plan?"

  …

   After reading the entire case, Lu Chen's head became big.

   is just the patient's auxiliary examination and laboratory test sheets, all of which are more than 20 pages of A4 paper.

   This patient's condition is so complicated that Lu Chen has never seen it before.

   "I'm going, this patient information, I'm dizzy!"

   Yu Weiguang's face was embarrassed.

  The case is still written in English. It really takes a lot of work for him to really understand it.

   Because Lu Chen has the "Literature Reading" skill card, there is no obstacle to reading at this time.

   "It's too complicated!" Lu Chen shook his head.

   After the doctor's description, he still didn't have any clues.

   However, the three questions of the doctor in charge are actually a series of related questions.

   Only by finding out the cause of hyperkalemia can the final diagnosis and decision on the next treatment plan be made.

   solves a problem, and the next problem is solved.

   about ten minutes later.

   The first Mayo's native doctor began to speak.

   The first focus is on the etiological analysis of hyperkalemia.

"The balance between potassium intake, intracellular transfer and urinary excretion determines the final serum potassium concentration. Persistent hyperkalemia mainly occurs when urinary potassium excretion is reduced, which is commonly seen in the following three conditions, namely renal failure. , distal tubule sodium transfer or decreased tubule fluid flow, hypoaldosteronism…”

   As expected of Mayo's doctor!

   Even in such a complex case, the analysis breakthrough can be accurately found at the first time.

   As long as it is hyperkalemia, there are no more than these reasons.

   Immediately afterwards, several doctors conducted an in-depth analysis of the cause of the patient's hyperkalemia.

   Several of the doctors, whom Lu Chen had met a few times, were all leading figures in the Department of Cardiology and Endocrinology.

"In patients with renal failure, although transcellular transport prevents the development of acute hyperkalemia, these patients eventually develop hyperkalemia because the effects of insulin and epinephrine taper off in the hours after a meal. "

   In this patient, however, her renal function was acceptable and renal failure could not explain her persistent hyperkalemia.

   "When the kidneys have an adequate glomerular filtration rate, the increased transport of sodium and water in the distal tubules will produce a high gradient and dilutive tubulofluid, promoting potassium excretion."

   However, despite the removal of unilateral kidney in this patient, the renal clearance function remained good.

   Therefore, persistent hyperkalemia cannot be explained by mild renal dysfunction!

   As for hypoaldosteronism, the patient's blood tests showed no significant decrease in renin activity or aldosterone concentration.

   Therefore, high potassium caused by hypoaldosteronism is temporarily excluded!

  …

   Everyone present was a little confused!

   analyzed the causes of hyperkalemia in a large circle.

   In the end, all the causes were ruled out.

   No wonder this patient was referred to Mayo!

   Cases of this difficulty are almost at the ceiling level.

   For a time, the entire assembly hall fell into contemplation.

   "Damn it, I think the analysis of the previous professors is already very powerful!" Yu Weiguang approached Lu Chen and said, "I didn't expect them to be wrong, so what's the reason?"

  Lu Chen frowned.

  According to his current knowledge reserve, he is also unable to analyze the cause of the patient's hyperkalemia.

   However, he has systematic help.

   The current causes of high potassium are the ones mentioned above.

   That's easy!

  Lu Chen put all possible diagnoses in the system and went around.

   As long as it is an existing disease, it should be able to be diagnosed.

  Lu Chen was really afraid that it was a rare disease, one that he had never seen before.

   That oneself is really a waste!

   Even if there is a system, he is a clever woman who cannot cook without rice.

   However, today's luck is on Lu Chen's side.

   After Lu Chen tried dozens of times, the system beep finally sounded!

  …

   "Congratulations, the completion of the system upgrade has increased!"

   Looking at the prompt popped up by the system, Lu Chen frowned.

  Why this diagnosis?

   "Isn't this diagnosis just denied by the professors collectively?" Lu Chen muttered.

   "Ah? What did you say?" Yu Weiguang asked in confusion when he heard Lu Chen's muttering.

"nothing."

  Lu Chen turned his attention to the professor who was still analyzing his condition.

   If he stands up to express his opinion at this time, he must give the corresponding reasons.

   However, the system only gives a diagnosis, and does not give a reason for the diagnosis.

   "Why on earth is this diagnosis?"

  Lu Chen was constantly deliberating in his heart.

   It is really not an easy task to overthrow all your previous ideas and then find a reason that conforms to the system diagnosis.

  …

   Mayo Case Discussion Venue.

   is only the first case of "hyperkalemia", and everyone has been discussing it.

  Each professor has his own reasons, but no one can convince anyone.

   Now, the time for the first case discussion is coming to an end.

   If there are no more constructive comments, this discussion can only be abandoned.

   "Are there any other doctors who come up with their own ideas?" The doctor in charge of the bed looked around on the rostrum.

   Looking forward to a professor who can give a different explanation for the cause of high potassium.

   "If there is no one, then this case discussion..."

   Just when the doctor in charge of the bed was about to announce the end of the first case discussion, someone in a later row raised his hand!

  Doctor tube bed immediately stopped, overjoyed, and looked at the raised hand.

   But then, the smile on his face dimmed again.

   is a Chinese doctor?

   And it is a relatively unfamiliar face, definitely not Mayo's doctor, most likely a visiting scholar.

  Doctor tube bed was a little disappointed, but he still immediately asked the staff to hand over the microphone to Lu Chen.

  The staff at the venue quickly handed the microphone to Lu Chen.

"I'll go, Lu Chen, you're amazing!" Yu Weiguang looked surprised when he saw Lu Chen stand up, "This is a good opportunity to show your face, even if you say it wrong, it doesn't matter, just give your reasons. Enough is enough!"

   "Yes." Lu Chen nodded slightly, then slowly stood up in the eyes of everyone.

   "Hello Professor, I'm Lu Chen, a visiting doctor from Huaxia."

  Lu Chen first made a self-introduction. This is the regulation of the venue, and it is also convenient for him to earn thanks points.

   "Hello, if you have any unique ideas, you can say them." The doctor tube bed nodded with a smile.

  Lu Chen pondered, after thinking just now, he had a clue in his heart.

   He doesn't need to explain the patient's entire condition clearly now, he just needs to give a head and give his reasons.

   It is enough to play the role of attracting others and guide these experts and professors to make the most correct choice.

   "I think the cause of this patient's hyperkalemia is...hypoaldosteronism!"

   Lu Chen's voice just fell, and the entire venue immediately burst into whispers.

   In the discussion of others just now, this diagnosis has been completely ruled out!

   Many people cast doubts or mocking glances at Lu Chen.

   Some people are even thinking that this doctor Huaxia stood up to speak, nothing more than grandstanding and showing his face in the global live broadcast.

   However, there were very few cardiologists in Mayo who recognized Lu Chen.

   Recently, Lu Chen frantically participated in case discussions in the Cardiology Department, so he also met some cardiologists.

  Lu Chen's performance in other previous case discussion conferences still surprised them.

   They didn't feel any surprise at Lu Chen's sudden remarks.

  …

   At this time, on the podium.

  Doctor Tube Bed's brows furrowed, he thought that this Huaxia doctor might have some special views.

  I just didn't expect it, he also came with his mouth open.

   This diagnosis of hypoaldosteronism has been ruled out by other doctors.

   And the reason is quite good. In the blood test of the patient, there was no hyperchloremic acidosis, and the renin activity and aldosterone concentration did not decrease!

  Lu Chen doesn't care what other people think.

   The system has already made a judgment. After so many years of getting along with the system, he still believes in the system.

   "Then can you explain that hyperchloremic acidosis was not found in the patient's blood test?"

  The podium went up, and the doctor in charge of the bed asked his question as usual.

   In his opinion, the visiting doctor from Huaxia in front of him could never explain the test result.

   Lu Chen smiled and said slowly: "Although all patients with hypoaldosteronism will have varying degrees of hyperkalemia, all of them will have hyperchloremic acidosis!"

   This is an example of inverse inference not valid.

   "Aldosterone maintains or participates in the stability of the body's balance to some extent. When renal function is good, the effect of aldosterone deficiency on renal acid excretion can be supplemented; when renal function is reduced, the benefit of supplementation will be weakened."

   "If hypoaldosteronism is supplemented with exogenous mineralocorticoids, it can correct some of the acidosis! I saw in the patient's case data that she had been treated with exogenous mineralocorticoids before."

  Lu Chen stared at the doctor on stage.

   The doctor of the tube bed was slightly taken aback, "If you want to explain it like this, it's barely plausible. However, the patient's renin activity is low, which is asymmetrical to the state of insufficient volume. How can this be explained?"

   After Lu Chen's explanation just now.

  In the venue, the eyes of everyone looking at Lu Chen began to change.

   It turns out that this Huaxia doctor is not aimless, but has his own ideas and reasons.

   However, just like this, it is not enough to overturn the previous diagnosis!

  Lu Chen heard the doctor's question, thought for a moment, and continued: "I think the appearance of these states you mentioned may be related to the patient's unilateral nephrectomy, because the kidney is the main source of renin in the circulation!"

   "Because of the presence of hyporeninemia, the effector that could be downstream of renin in this patient is the potent and prominent angiotensin II."

"In this patient, hypotension and inappropriate renal salt loss may be the result of insufficient glomerular feedback due to a relative lack of renin. In addition, the patient's GFR remained good also reflecting poor glomerular feedback, leading to Insufficient drop in GFR!"

"Bubble-bulb feedback is a negative feedback loop that maintains the internal environment. When the salt concentration at the end of the ascending branch of the loop of medullary is abnormally elevated, the cells of the plaque densities will inform the change, causing vasoconstriction of the afferent arterioles and a decrease in GFR, thereby limiting the distal end. tubules lose salt..."

  …

  Lu Chen's explanation, in the eyes of a layman, is just listening to heaven.

   But in the eyes of doctors like Mayo, it seems like a whole new idea has been opened!

   Many professors looked at Lu Chen with incomparable surprise.

   The clinical thinking of this Huaxia doctor has reached the point of perfection!

   On the rostrum at this time, the doctor in charge of the bed has long been stunned.

Every sentence of    Lu Chen was something he hadn't thought about before.

  Because most of them have subconsciously ruled out the existence of hypoaldosteronism, and did not continue to think at all.

   "The patient has been in a state of hypovolemia, why is the blood sodium concentration maintained at the upper limit of normal?"

  Doctor Tube Bed asked his last question.

   These questions are just like a student asking a teacher, they are simply asking for advice.

  Lu Chen smiled and blurted out: "It's actually very simple. The possible reason for the higher sodium concentration than expected is that the defect of the RAAS system leads to the decline of water regulation ability!"

"For this patient, his adrenocorticoid function was normal, but he also had hyperkalemia and a low basal TTKG, suggesting insufficient potassium excretion. Considering the patient's history of unilateral renal and adrenalectomy, and the need for blood renal The activity of renin is relatively low, so I fully suspect that it is a relative insufficiency of renin and aldosterone.”

  …

After    Lu Chen's remarks, the entire venue fell into a long silence.

   Everyone is recalling Lu Chen's words.

   Even viewers watching the global live broadcast are thinking about the possibility of Lu Chen's opinion.

   There are still some people who are looking for, who is this visiting doctor from Huaxia in front of him?

  A problem that even so many Professor Mayo could not solve was solved by a little-known doctor?

   From the beginning, everyone subconsciously ruled out a diagnosis of hypoaldosteronism.

   Now, they have begun to reflect slowly and accept Lu Chen's remarks.

   It wasn't until Lu Chen sat back in his seat, the doctor in charge of the bed on the rostrum, that he regained his senses.

   "Thank you for your speech, Dr. Lu Chen from Huaxia."

   His words have long since lost the arrogance that he used to treat Lu Chen before.

   On the contrary, there was a hint of admiration in his eyes.

   Scholars are sometimes very simple, and they have an unbelievable attachment to knowledge and truth.

   This time, it was Lu Chen who gave them hope in pursuing the final truth.

   "Damn it, Lu Chen, you, you, you... It's so awesome!"

   Lu Chen sat down when Yu Weiguang came over.

   There was excitement in his eyes.

Before   , he thought Lu Chen was just here to show his face.

   Unexpectedly, Lu Chen was so unexpected that he directly overturned everyone's previous diagnosis.

   And gave a diagnosis that no one thought about, and it makes sense!

   This kind of case discussion is far more shocking than surgery.

   Surgical operation, only familiar with the hands.

   But clinical thinking is beyond words.

  Lu Chen just smiled.

  The system is still awesome!

   What he is most looking forward to is the next thank you.

   Sure enough, after a while.

The    system prompt sounded one after another.

   "Congratulations, +100 thanks from Rogers Lambert!"

   "Congratulations, received +100 thanks from Agat Parsons!"

   "Congratulations, received +50 thanks from Irakli Haley!"

  “…”

   The system beeps, jumping non-stop.

   Those who were present, and those who watched it on the live broadcast platform, all contributed some gratitude to Lu Chen.

  Although this is a professional academic live broadcast, there are viewing restrictions, and there are not many people watching the live broadcast, but there are tens of thousands of people worldwide!

   At this time, Lu Chen keenly noticed that a different prompt popped up in the system.

   "Earn the upper limit of the gratitude value, and open the next level of the mall!"

   Da Zhang, asking for a wave ticket, it’s not too much.

   (end of this chapter)