I can see health

Chapter 863 China's Future (The Fourth Bigger Chapter!)
Chapter 859 The Future of Huaxia
Huaxia First Affiliated Hospital of Kyoto.

Town Hall.

Looking at the continuously playing coronary angiography images in front of them, everyone fell into deep thought.

Even someone as well-informed as Qin Sifeng didn't have any clue for a while.

He has seen coronary angiography images of myocardial infarction, cardiomyopathy, and myocarditis, but he has never seen such "thick and thin" blood vessels.

Normal myocardial infarction vessels have local stenosis.

But the patient's blood vessels, in addition to local stenosis, are also dilated!
"You can answer any opinions you have. Don't be afraid of making mistakes. You can speak up if you have an idea."

On the rostrum, Kebed smiled and said to everyone.

"This case was the result of a joint discussion between me and a doctor from Huaxia. He is also on the scene today."

Yao Jie's heart moved when she heard this.

This American doctor should be referring to Senior Brother Lu Chen, right?

I didn't expect Senior Brother Lu Chen to be so powerful that he could even solve this kind of case!

"Yao Jie, Hua, I remember correctly, the man on the stage should be Lu Chen, right?"

Suddenly, Yao Jie spoke out as a boy.

"How do you know?" Yao Jie frowned.

Although Lu Chen stayed in the capital, it was many years ago.

"I definitely remember." Wu Lang twitched his lips, "I remember clearly when he came to the department to look for you."

Back then, Wu Lang pursued Yao Jie, but Lu Chen's sudden appearance made him lose this thought.

However, with Lu Chen's departure, both he and Yao Jie stayed in the capital.

His heart began to agitate again.

"I see, if you don't ask Lu Chen, he should know the diagnosis of this case." Wu Lang suddenly whispered, "As your brother, I think he should tell you the answer. If you perform in front of a big leader, it must be quite brilliant."

Wu Lang's voice dropped a few more decibels, "Maybe, you can get a Mayo spot."

"Hmph, I wouldn't do such a thing!" Yao Jie rejected Wu Lang immediately, "This is tantamount to cheating, whether Senior Brother Lu Chen is willing or not, I will definitely not ask him!"

"Hey, we have never seen this case before." Wu Lang smiled disdainfully, "Rare diseases, if I see them once, I will definitely be able to diagnose them next time. Mayo is such a rare disease that is more common. Actually, it’s nothing after all.”

Hearing Wu Lang's words, Yao Jie felt that he hated him even more, so she stopped replying.

Wu Lang consciously encouraged failure, shrugged, and stopped talking.

However, although Yao Jie didn't ask Lu Chen for an answer, she thought about it in her heart.

If she asked Brother Lu Chen this question, would he give him the answer?
……

At the scene, there was finally a doctor in charge of Huaxia, who stood up bravely and replied.

"Is this case like Kawasaki disease in children?"

Kebed smiled and shook his head: "You still have ideas, but the main manifestation of Kawasaki disease is vascular stenosis, but this patient also has vascular dilation in vascular stenosis."

"Oh, I was wrong." Huaxia's attending doctor scratched his head and sat down.

"No one else answered?"

Kebed looked around and saw no one raised his hand, so he smiled, "Okay, then I won't waste any more time and start announcing the answer."

Then, on the projector on the rostrum, an English text appeared immediately.

Translated into Chinese, it means "coronary dilation"!
"Yes, this disease is actually very rare, called coronary artery dilation." Kebed continued, "I checked Mayo's own database, and finally found the name of the disease. Its incidence rate in Chinese people is not high, mainly Still in Europe, America and other places, the incidence rate varies from study to study, and is about 0.02%.”

After hearing Kebed's words, the Huaxia doctors below all began to look up relevant information on the Internet.

With Kebed's explanation, and everyone's own understanding.

The truth of this special case began to slowly emerge in front of everyone.

Coronary ectasia, English name is CAE.

Kebed continued:
"In short, it is actually the abnormal dilation of the subepicardial coronary artery. The diameter of the dilated lumen exceeds 1.5 times that of the adjacent normal segment, and if the diameter exceeds 2 times the diameter of the adjacent normal segment, it is limited The dilation is called a coronary aneurysm (CAA)."

"If the diameter exceeds 4 times the diameter of the normal segment, it is a giant CAA."

"CAE/CAA most commonly involves the right coronary artery (RCA), and the lesions are mostly diffuse. It is followed by the left anterior descending coronary artery (LAD), the left circumflex coronary artery (LCX), and the left coronary artery is often segmental when it is involved. The left main (LM) of the coronary arteries is less commonly involved."

"The case I'm introducing to you today, more precisely, should be coronary artery dilatation CAE class I."

As soon as the words fell, everyone began to discuss.

A rather rare case indeed!
After what Kebed said, the disease is now easy.

Judging from the symptoms, electrocardiogram, and ultrasound images, it is angina pectoris.

But in fact, the internal pathological changes are extremely complicated.

"About this case, if you have any doubts, you can ask questions!" Kebed smiled.

As soon as he finished speaking, Wu Lang suddenly raised his hand.

Yao Jie on the side was a little surprised.

She knew Wu Lang's level.

He has published a few SCI papers in China, which is a bit clever, but what good advice can he have when encountering such a large academic conference?
"Okay, man, please answer."

Immediately, a staff member at the scene handed the microphone to Wu Lang.

Afterwards, Yang Feng, Qin Sifeng and other hospital leaders immediately set their sights on this young doctoral student.

Being stared at by so many celebrities, Wu Lang was also a little apprehensive.

But as soon as he thought that speaking could make the leader know, he suppressed the panic in his heart.

"Professor Kebed, what I want to ask is about the grading of coronary artery dilatation you mentioned." Wu Lang said slowly, "This patient is very serious, but the grading is only grade I, so grade II cannot grow into it." Candied haws with beads on them?"

Kebed may not understand what candied haws are, but someone immediately explained, and he understood.

Afterwards, Kebed smiled: "Actually, the CAE classification is arranged in descending order of severity, grade I is diffuse dilation of two or three vessels, grade II is diffuse dilation of a single vessel and localization of another vessel Grade III is diffuse dilation of a single vessel, and Grade IV is local segmental dilation.”

"This...thank you for your explanation, Professor."

Hearing Kebed's words, Wu Lang touched the back of his head in embarrassment.

It never occurred to him that this classification puts the heaviest in front and the lightest in the back.

It is the opposite of hypertension classification, cardiac function classification, conduction block classification, and Lown premature ventricular classification!
This time, not only did he not show his face, but he also made an own joke.

Wu Lang sat down quickly.

Yao Jie on the side pursed her lips and smiled lightly.

This Wu Lang usually likes to show off, but on this occasion today, he is still showing off his cleverness.

On the stage, Kebed smiled very calmly: "There is a saying in Huaxia, those who don't know are innocent. The young student just now behaved very well. Otherwise, I wouldn't have the chance to tell everyone about this classification."

When Wu Lang heard this, he blushed again with a "swish".

Why do these words sound like "sarcasm" to him?
"Do you have any other questions about this disease?" Kebed continued, "If not..."

At this moment, Yao Jie raised her hand suddenly.

"Okay, lady, you can answer." Kebed pointed to Yao Jie who was seated in the front row.

Yao Jie stood up slowly, she took a peek at Lu Chen, and then slowly shifted her gaze to Kebed.

At this moment, Lu Chen also spotted Yao Jie in the front row.

He was also very surprised, he did not expect to meet Junior Sister Yao Jie again on this occasion.

……

Yao Jie looked at Kebed, and slowly expressed her doubts.

"Kebed, from your description just now, I know the manifestations of this coronary artery disease, but after all, what are the pathological changes of this dilation and stenosis?"

This question involves the level of pathophysiology, but it has some value.

Kebed immediately said: "Different diseases have different mechanisms of CAE, and the potential pathogenesis includes degradation of extracellular matrix, activation of systemic and local inflammatory processes, changes in nitric oxide (NO) metabolism, renin-angiotensin-aldosterone system (RAAS) activation, genetic factors, and interventional correlates."

"You may also have seen reports of myocardial infarction in children, many of which are due to 'Kawasaki disease', which is the most common cause of coronary artery dilation in children. In adults, coronary artery dilation is mostly the result of atherosclerosis .”

"Atherosclerosis?" Yao Jie felt even more surprised, "Doesn't atherosclerosis cause blood vessels to narrow, why does it also cause coronary arteries to dilate?"

This question also expressed the aspirations of everyone present.

Dilation and narrowing are opposites.

Why does a person's coronary vessels appear at the same time?

Kebed explained calmly: "Atherosclerosis involves the intima, media, and adventitia, which promotes the proteolysis of the extracellular matrix, and at the same time enhances the local inflammatory response, destroys the elasticity of blood vessels, and reduces the pressure of the blood vessel wall on blood flow." tolerance, leading to vascular remodeling..."

"Under the multiple effects of arteriosclerosis, local inflammation, and vascular remodeling, it leads to a complex situation of coexistence of dilation, stenosis, and thrombus."

CAE is divided into congenital and acquired, and congenital is rare.

Among acquired CAEs, atherosclerosis is the most common etiology, accounting for 50% of adult CAEs.

The most common cause of CAE in children is Kawasaki disease, in addition to infectious diseases (sepsis, fungal emboli, syphilis, Lyme disease), connective tissue diseases (Marfan syndrome, Ehlers-Danlos syndrome, hard skin diseases), drug-related, traumatic and iatrogenic reasons.

Male sex, hyperlipidemia, hypertension, and smoking were definite risk factors.

"If you talk about the changes in detail, it won't be clear in a while." Kebed smiled at Yao Jie, "If you are interested, we will upload this medical record later for everyone to learn from."

"Thank you, Professor Kebed." Yao Jie thanked quickly, "Also, I have another question."

Kebed was about to withdraw, but Yao Jie spoke up again, then nodded with a smile, "You can ask."

"Since they are both caused by atherosclerosis, will the symptoms of vasodilation be similar to those of vascular stenosis?"

Kebed glanced at Yao Jie appreciatively, "You are right. Most CAEs do not cause obvious symptoms, and are often found incidentally during coronary angiography, but if symptoms occur, the most common symptom is angina pectoris, and myocardial infarction can also occur Thrombosis, embolism and local vascular rupture are the main causes of myocardial infarction and sudden death."

Yao Jie nodded and continued to ask: "Professor, can a stent be placed on such a lesion?"

Generally speaking, stenosis caused by atherosclerosis requires a stent.

However, this patient also had dilatation.

Kebed shook his head: "Dilated arteries are prone to thrombosis, and conventional stent implantation is obviously riskier in the face of such lesions. Through research, we believe that coil embolization can be performed on the dilated site, just like the treatment of brain aneurysms, but The risk is still high. At present, there are not enough studies to guide interventional treatment, and the first choice is coronary artery bypass grafting (CABG)."

Having said that, Kebed glanced at Yao Jie, and motioned for her to continue asking questions.

Yao Jie quickly thanked: "Thank you, Professor Kebed, I have no problem for now."

"Okay, thank you for your question." Professor Kebed smiled at Yao Jie and gave a thumbs up, "Your clinical thinking is very active, and you can think of these questions at the first time, and many of them are critical. The problem is not so simple."

Hearing Kebed's praise, Yao Jie smiled shyly.

Aside, Qin Sifeng had a smile on his face.

This is his student!
In front of the leader today, he really gave him face!
Everyone thought that this case was over, but unexpectedly, Kebed still has content to share with you.

"As the lady asked just now, the best way to deal with this disease is coronary bypass." Kebed said helplessly, "But the client refused to bypass the coronary artery. Do you think there is a better treatment?"

This time, more people raised their hands to answer questions.

After Yao Jie's question and answer, everyone was not so restrained.

A senior deputy chief physician said: "I think it's better to take dual anti-platelet drugs, aspirin and clopidogrel, and then supplemented with lipid-lowering drugs."

Kebed shook his head: "It's a good idea, but it's one-sided. Do you have any other opinions?"

Yao Jie had been thinking about this question with her head down, and she immediately raised her hand.

"Okay, Ma'am, please continue to answer." Kebed saw Yao Jie raised her hand again, and immediately called her name.

Yao Jie stood up and thought for a while: "Urgent measures should be taken at extreme times. As you said just now, dilated blood vessels are prone to thrombosis, so I think anti-platelet therapy is definitely not enough!"

"I think 'three antibodies' can be used to maintain the treatment!"

The so-called "third antibody" is the use of two antiplatelet drugs, aspirin and clopidogrel, plus warfarin (rivaroxaban) for anticoagulation.

"How to use the third antibody?" Kebed asked with a smile.

Yao Jie continued: "I have never seen this type of patient, but it can be compared to patients with coronary heart disease and atrial fibrillation. This type of patient also needs to use a third antibody during the unstable period."

"That is, clopidogrel was stopped after 1 month, aspirin and warfarin were continued, and the international normalized ratio (INR) was controlled between 2.0 and 3.0 after multiple reexaminations."

"In addition, while applying the 'third antibody', increase the dosage of statins. If the patient's symptoms can be controlled stably, it is also possible not to undergo coronary artery bypass grafting."

As soon as the words fell, Kebed gave Yao Jie a thumbs up again.

"That's great, you actually know the treatment method for analog patients! You are right, it is basically the same as the treatment method we choose."

The PTT picture on the screen continues to switch.

The patient's treatment method appeared in front of everyone.

After everyone's comparison, it is indeed similar to what Yao Jie said just now.

This time, everyone present had to look at this little girl, Yao Jie, with admiration.

Agile clinical thinking mode, fearless in the face of Mayo's top professors.

Even Yang Feng, the director of the Department of Cardiology, was asking who this girl was a student of.

The one with the brightest smile now is Qin Sifeng!
Yao Jie gave him too many surprises today.

……

On the stage.

Lu Chen looked at the calm and fearless Yao Jie, and felt happy for her.

Unknowingly, the little girl who used to follow him to make house rounds has grown up!
Lu Chen couldn't help but sigh in his heart.

Over the years, not only has he been growing, but the group of people around him has also been growing.

Gu Xinyue, Ke Yue, Wang Zihao, Ke Yue, etc., and even Fan Zhiping, who is an old graduate student, are constantly studying and learning!
Perhaps, the road to medicine in the future will not be so lonely with the company of so many friends.

Perhaps, in the future, China's medical industry will definitely be better because of the existence of so many young talents!
　I updated 1w words yesterday, asking for votes and subscriptions, isn't it too much?
　　
　
(End of this chapter)