I can see health

Chapter 845 A Speech That Astounds the World
At this time, more than 200 people had gathered in the conference hall where Mayo conducted case discussions.

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

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

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

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

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

"Don't tell me, as far as I know, doctors in Kyoto 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 equivalent to a small medical forum.

Mayo is also a big spender, holding such meetings every quarter.

It can only be said that Mayo is really rich and powerful, and they have encountered many difficult cases, so they are fully capable of hosting this kind of case discussion meeting.

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

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

"Is he Mayo's boss?" Lu Chen wondered.

But why does the boss participate in this kind of academic conference?

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

"That's pretty good." Lu Chen still admired Mayo's management methods.

Unlike the leadership of some hospitals, there are no laymen in the medical profession at all.

So what good policy 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 hope to try to apply for the Mayo Fellowship with you." Yu Weiguang sighed.

After experiencing this purely medical environment, it is difficult for anyone to be willing to leave.

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

The average person simply cannot afford the medical expenses involved.

……

With the Mayo CEO's speech, the quarterly case discussion began.

Although there are simultaneous live broadcasts by major media around the world, Mayo does not talk about most etiquette.

Without procrastinating, he directly brought up difficult cases.

It is similar to the previous procedure, firstly, it is performed by a doctor in charge of the bed and the condition is reported.

Then ask questions and be answered by experts, and finally it is time for free questions and answers.

"Case discussions have begun."

Yu Weiguang whispered something.

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

first case.

The patient was a 49-year-old female.

He was referred to Mayo Hospital for "4 years of hyperkalemia".

There was a history of obesity in the past, and gastric band surgery was performed.

In addition, the patient also had fibromyalgia and bipolar disorder.

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

Before operation, serum potassium and blood pressure were normal.

A few months after the operation, the patient began to feel general fatigue and mild episodic headache.

Seeing a doctor at a local hospital, 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 does the patient have persistent hyperkalemia?"

"Second, what is the patient's diagnosis?"

"Third, what is the next step in the treatment plan?"

……

After reading the whole case, Lu Chen felt dizzy.

Just the patient auxiliary examination and laboratory test form, there are more than 20 pages of A4 paper.

This patient's condition is so complicated that Lu Chen has seen it from outside.

"I'm going, I'm dizzy from reading this patient's information!"

Yu Weiguang showed embarrassment.

The case is still written in English, and it will take a lot of effort for him to really understand it.

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

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

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

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

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

Once a problem is solved, the next problem is solved.

After about 10 minutes.

The first Mayo native physician began to speak.

The first thing to focus on is the etiology analysis of hyperkalemia.

"The balance between potassium intake, intracellular and extracellular transfer, and urinary excretion determines the final concentration of potassium in the blood. Persistent hyperkalemia mainly occurs when urinary potassium excretion decreases, and it is common in the following three conditions, namely renal failure , distal tubule sodium shift or decreased tubule fluid flow, hypoaldosteronism..."

As expected of a Mayo doctor!

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

As long as it is hyperkalemia, there are several reasons for it.

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

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

"In patients with renal failure, although transcellular transport prevents the onset of acute hyperkalemia, these patients eventually develop hyperkalemia because the effects of insulin and epinephrine gradually wane over the hours after a meal. "

In this patient, however, her renal function is acceptable, and renal failure cannot explain her persistent hyperkalemia.

"When the kidney has an adequate glomerular filtration rate, the increased transport of sodium and water by the distal tubule will produce an electric gradient and dilute tubular fluid that promotes potassium excretion."

However, in this patient, despite unilateral nephrectomy, renal clearance remained good.

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

As for hypoaldosteronism, in the patient's blood test, there was no obvious renin activity or a decrease in aldosterone concentration.

Therefore, hyperkalemia caused by hypoaldosteronism has also been ruled out for the time being!
……

Everyone present was a little confused!
The causes of hyperkalemia have been analyzed in a large circle.

Finally, all causes were ruled out.

No wonder this patient was transferred to Mayo!

Cases of this difficulty have almost reached the ceiling level.

For a moment, the entire assembly hall was lost in thought.

"Damn, I think the analysis of the previous professors is already very good!" Yu Weiguang leaned over to 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 was also unable to analyze the cause of the patient's hyperkalemia.

Still, he has systemic help.

The current causes of hyperkalemia are the ones mentioned above.

That's it!
Lu Chen put all possible diagnoses in the system for a while.

As long as the disease is currently present, it should be able to be diagnosed.

Lu Chen was really afraid of some rare disease, one he had never seen before.

Then I am really useless!

Even if there is a system, he is still a clever woman who can't cook without rice.

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

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

……

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

Seeing the prompt popped up by the system, Lu Chen frowned.

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

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

"It's nothing."

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

If he stands up to make an opinion at this time, he must give corresponding reasons.

However, the system only gave a diagnosis, and did not give the reason for the diagnosis.

"Why the hell is this diagnosis?"

Lu Chen kept deliberating in his mind.

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

……

Mayo case discussion venue.

Just the first case of "hyperkalemia" caused a lot of discussion among the people.

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

Seeing that the time for the first case discussion is coming to an end.

If there are no more constructive suggestions, this discussion can only be done.

"Are there any other doctors who put forward their own ideas?" The doctor in charge looked around on the rostrum.

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

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

Just as the doctor in charge was about to announce the end of the discussion on the first case, someone raised his hand a little behind the row!

The doctor in charge of the bed immediately paused, overjoyed, and looked towards the person who raised his hand.

But immediately, the smile on his face faded again.

Is it a Huaxia doctor?
And it was a relatively unfamiliar face, definitely not a Mayo doctor, probably a visiting scholar.

The doctor in charge of the bed was a little disappointed, but he immediately asked the staff to pass the microphone to Lu Chen.

The venue staff quickly handed the microphone to Lu Chen.

"I'm going, Lu Chen, you're too good!" Yu Weiguang was startled when he saw Lu Chen standing up, "This is a good opportunity to show your face, it doesn't matter if you say something wrong, just tell me your reasons. Enough is enough!"

"Yeah." Lu Chen nodded slightly, and then stood up slowly under the eyes of everyone.

"Hi, professor, I'm Lu Chen, a visiting doctor from Huaxia."

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

"Hello, if you have any unique ideas, you can tell them." The doctor in charge nodded with a smile.

Lu Chen pondered for a while, after thinking about it just now, he had some clues in his mind.

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

It is enough to act as a catalyst to guide these experts and professors to make the most correct choice.

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

As soon as Lu Chen's words fell, the whole venue immediately started whispering.

In the discussion of other people just now, this diagnosis has been completely ruled out!
Many people cast doubtful or mocking glances at Lu Chen.

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

However, there are still very few cardiologists at Mayo who recognized Lu Chen.

Recently, Lu Chen frantically participated in case discussions in the Department of Cardiology, so he also got to know some cardiologists.

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

They were not surprised by Lu Chen's sudden speech.

……

At this time, on the rostrum.

The doctor in charge of the bed frowned deeply, and he thought that this Huaxia doctor might have some special opinions.

It's just that he didn't expect that he also opened his mouth to come.

This diagnosis of hypoaldosteronism had been ruled out by other physicians.

And the reason is quite good, in the patient's blood test, there is no hyperchloremic acidosis, renin activity and aldosterone concentration have not decreased!

Lu Chen didn't care about other people's opinions.

The system has already made a judgment, and 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?"

Going up the podium, the bed doctor asked his own question as usual.

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

With a smile on the corner of Lu Chen's mouth, he said slowly: "Although all patients with hypoaldosteronism will have hyperkalemia to varying degrees, they will not all suffer from hyperchloremic acidosis!"

This is an example where inversion does not work.

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

"If you supplement exogenous mineralocorticoids for hypoaldosteronism, you can correct part of the acidosis! I saw in the patient's case file that she had previously received exogenous mineralocorticoids."

Lu Chen stared closely at the doctor in charge of the bed on the stage.

The doctor who managed the bed was slightly taken aback, "If you want to explain it this way, it is barely reasonable. 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 slightly.

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

However, it is far from enough to overthrow the previous diagnosis just like this!

When Lu Chen heard the doctor's question, he thought for a while, 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!"

"Due to the presence of hyporeninemia, the potent and prominent angiotensin II may be a potent and prominent effector downstream of renin in this patient."

"In this patient, the hypotension and inappropriate renal salt loss may have been the result of insufficient tubulobulbar feedback due to the relative deficiency of renin. Furthermore, the patient's good GFR also reflected poor tubulobulbar feedback, leading to Not enough GFR drop!"

"Tubulobulbar feedback is a negative feedback loop that maintains the internal environment. When the salt concentration at the end of the ascending limb of the loop of Henle is abnormally elevated, the macula densa cells inform the change, causing vasoconstriction and a decrease in GFR in the afferent arterioles, thereby limiting the distal Small tube loses salt..."

……

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

But in the eyes of doctors like Mayo, it seems that they have opened up a whole new way of thinking!

Many professors looked at Lu Chen with incomparable astonishment.

The clinical thinking of this Huaxia doctor has reached the point of perfection!
At this time on the rostrum, the doctor in charge of the bed was already stunned.

Every sentence of Lu Chen was something he had never thought about before.

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

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

The bed doctor asked his last question.

These questions, just like students asking the teacher, are simply asking for advice.

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

"For this patient, the corticosteroid function is normal, but there is hyperkalemia and low TTKG at the same time, suggesting insufficient potassium excretion. Considering that the patient has a history of unilateral nephrectomy and Relatively low renin activity, so I fully suspect that it is a relative deficiency of renin and aldosterone."

……

After Lu Chen finished speaking, the whole venue fell into a long silence.

Everyone was reminiscing about Lu Chen's words.

Even the viewers who watched the global live broadcast were thinking about the possibility of Lu Chen's opinion.

There are still some people who are searching, who is this visiting doctor from China in front of him?
So many problems that Professor Mayo couldn't solve, were actually solved by a little-known doctor?
From the beginning, the diagnosis of hypoaldosteronism was subconsciously ruled out by all.

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

It wasn't until Lu Chen sat back to his seat, the bed doctor on the rostrum, that he came back to his senses.

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

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

Instead, there was a trace of admiration in his eyes.

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

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

"Damn it, Lu Chen, you, you, you... are so awesome!"

As soon as Lu Chen sat down, Yu Weiguang came over.

There was excitement in his eyes.

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

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

And it makes sense to give a diagnosis that no one has thought about!
This kind of case discussion brought shock to everyone, far higher than surgery.

Surgical operation, only familiar with hands.

But something like clinical thinking is hard to put into words.

Lu Chen just smiled slightly.

The system is still awesome!

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

Sure enough, after a while.

The system prompts sounded one after another.

"Congratulations, received a thank you value from Rogers Lambert +100!"

"Congratulations, received a thank you value from Agathe Parsons +100!"

"Congratulations, I received a thank you value of +50 from Irakli Hayley!"

"..."

The system beeps, jumping non-stop.

Those who were present and those who watched on the live broadcast platform all contributed part of their gratitude to Lu Chen.

Although this is a professional academic live broadcast, there are viewing restrictions, and the number of people watching the live broadcast is not many, but the total number of people worldwide is tens of thousands!
At this time, Lu Chen keenly noticed that a different prompt popped up in the system.

"Earn thank you points to the upper limit, and open the next level of shopping mall!"

　Dazhang, it's not too much to ask for wave tickets.

　　
　
(End of this chapter)