I Can See Health

At this time, more than 200 people had gathered in the conference hall where Mayo held case discussions.

Some of them are local doctors in Mayo, and some are visiting staff from outside.

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 around the world!" Yu Weiguang looked back at the people behind the venue.

"At this time, it must be late at night in China, right?" Lu Chen asked doubtfully.

"Don't mention it yet. As far as I know, doctors in Kyoto will organize doctors to watch the replays the next day." Yu Weiguang said, "There is more than one case routine today, involving many disciplines, not only cardiology. , and there are some cases of surgical simulation.”

Lu Chen understood clearly. .

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

Mayo is also very generous and holds such meetings every quarter.

It can only be said that Mayo is really wealthy, and they have encountered many difficult cases, and they are fully capable of hosting such a case discussion conference.

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

On the podium, a middle-aged man wearing gold-rimmed glasses came up.

"He is the boss of Mayo?" Lu Chen asked doubtfully.

But why would the boss attend such an academic conference?

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

"This is 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 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 hope to try to apply for Mayo Fellowship with you." Yu Weiguang sighed.

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

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

The average person simply cannot afford the medical expenses.

…

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

Although there is a simultaneous live broadcast by major media around the world, Mayo does not speak a lot of etiquette.

Without any delay, the difficult cases were brought up directly.

It is similar to the previous procedure. First, the bed doctor will perform the procedure and report on the condition.

Then the questions will be asked and answered by the experts. Finally, it is time for free questions and answers.

"The case discussion has begun."

Yu Weiguang whispered.

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

The first case.

The patient is a 49-year-old woman.

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

He had a history of obesity and had undergone gastric banding surgery.

In addition, the patient had 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 general weakness and experienced mild episodic headaches.

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

After the case was presented, the doctor in charge asked three questions.

"First, why does the patient have persistent hyperkalemia?"

“Second, what is this patient’s diagnosis?”

"Third, what is the next treatment plan?"

…

After Lu Chen read the entire case, his head felt heavy.

Just the patient auxiliary examination and laboratory test orders have more than 20 pages of A4 paper.

This patient's condition was so complicated that Lu Chen had seen it from outside.

"Here I go, I'm dizzy just looking at this patient information!"

Yu Weiguang looked troubled.

The medical records were written in English, and it would take a lot of effort for him to really understand them.

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

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

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

However, the three questions asked by the bedside doctor are actually a series of related questions.

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

Once one problem is solved, the next problem will be solved easily.

About ten minutes later.

The first native Mayo doctor began to speak.

The first thing to focus on is the analysis of the cause of high potassium.

"The balance between potassium intake, intracellular and intracellular transfer, and urinary excretion determines the final concentration of potassium in the blood. Persistent hyperkalemia mainly occurs when urinary potassium excretion is reduced, and is common in the following three conditions: renal failure , distal tubular sodium transfer or reduced tubular fluid flow, hypoaldosteronism..."

He is indeed a doctor from Mayo!

Even for such complex cases, the analysis breakthrough can be accurately found at the first time.

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

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

Lu Chen had met several of these doctors, all of whom were leading figures in the Department of Cardiology and the Department of Endocrinology.

"For patients with renal failure, although the transcellular transport department prevents the occurrence of acute hyperkalemia, these patients will eventually develop hyperkalemia because the effects of insulin and adrenaline gradually weaken within a few hours after a meal."

However, for this patient, her renal function is still good, so renal failure cannot be used to explain her persistent hyperkalemia.

"When the kidneys have sufficient glomerular filtration rate, the increased transport of sodium and water by the distal tubules will produce electrical gradients and dilute tubular fluid, promoting potassium excretion."

However, although this patient had one kidney removed, her renal clearance function remained relatively good.

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

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

Therefore, the hyperkalemia caused by hypoaldosteronism has been temporarily ruled out!

…

Everyone present was a little confused!

The causes of hyperkalemia were analyzed for a long time.

In the end, all the causes were ruled out.

No wonder this patient was transferred to Mayo!

This kind of difficult case is almost at the ceiling level.

For a while, the whole conference hall fell into deep thought.

"Damn, 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 other reasons are left?"

Lu Chen frowned.

According to his current knowledge reserve, he also couldn't analyze the cause of the patient's hyperkalemia.

However, he has the help of the system.

The current causes of hyperkalemia are those mentioned above.

That's easy!

Lu Chen put all possible diagnoses in the system.

As long as it is a disease that currently exists, it should be able to be diagnosed.

Lu Chen is really afraid that it is a rare disease that he has never seen.

Then he is really useless!

Even with the system, he is still a skilled cook without rice.

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

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

...

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

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

Why is it this diagnosis?

"Didn't the professors just deny this diagnosis?" Lu Chen murmured.

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

"Nothing."

Lu Chen cast his eyes on the professor who was still analyzing the condition.

If he stood up and made an opinion at this time, he must give a corresponding reason.

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

"Why is it this diagnosis?"

Lu Chen kept pondering in his heart.

It is really not an easy task to overturn all his previous ideas and then find a reason that meets the system diagnosis.

...

Mayo case discussion venue.

Just the first case of "hyperkalemia" was discussed by everyone.

Each professor had his own reasons, but no one could convince the other.

The time for the first case discussion was about to end.

If no constructive opinions were put forward, this discussion would have to be abandoned.

"Are there any other doctors who have put forward their own ideas?" The attending physician looked around on the podium.

He was looking forward to a professor who could give a different explanation for the cause of high potassium.

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

Just as the attending physician was about to announce the end of the first case discussion, someone raised his hand in the slightly later row!

The attending physician immediately paused, and with a smile on his face, he looked towards the raised hand.

But then, the smile on his face dimmed again.

Is it a Chinese doctor?

And it was a relatively unfamiliar face, definitely not a doctor from Mayo, most likely a visiting scholar.

The attending physician 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.

"Oh my god, Lu Chen, you are so amazing!" Yu Weiguang was surprised when he saw Lu Chen stand up. "This is a good opportunity to show off. It doesn't matter if you say something wrong, just give your reasons!" "Yes." Lu Chen nodded slightly, and then slowly stood up in the eyes of everyone. "Hello, professor, I am Lu Chen, a visiting doctor from China." Lu Chen first introduced himself. This was the rule of the venue, and it was also convenient for him to earn gratitude points later. "Hello, if you have any unique ideas, you can say it." The attending doctor nodded with a smile. Lu Chen pondered for a moment. After thinking just now, he had a clue in his mind. He didn't need to explain the patient's entire condition now, he just needed to give a head and give his reasons. It was enough to play a role in guiding 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 finished speaking, the entire venue immediately erupted in whispers.

In other people's discussion just now, this diagnosis has been completely ruled out!

Many people cast doubtful or mocking glances at Lu Chen.

Some people are even thinking that this Chinese doctor stood up to speak, which is nothing more than grandstanding and appearing in a global live broadcast.

However, a very small number of Mayo's cardiologists recognized Lu Chen.

During the recent period, Lu Chen had been participating in case discussions in the Department of Cardiology like crazy, and thus got to know some cardiologists.

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

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

…

At this time, on the rostrum.

The doctor in charge of the bed frowned deeply. He thought that this Chinese doctor might have some special views.

What I didn't expect was that he came right out of his mouth.

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

And the reason is quite good. The patient's blood test showed no hyperchloremic acidosis, and neither renin activity nor aldosterone concentration decreased!

Lu Chen didn't care what other people thought.

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

"Then can you explain that the patient's blood test did not reveal hyperchloremic acidosis?"

The doctor in charge came up to the podium and asked his question as usual.

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

Lu Chen said slowly with a smile on his face: "Although all patients with hypoaldosteronism will have varying degrees of hyperkalemia, they will not all develop hyperchloremic acidosis!"

This is an example where inference does not hold.

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

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

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

The doctor in charge of the bed was slightly startled, "If you want to explain it this way, it barely makes sense. However, the patient's renin activity is low, which is asymmetrical to his volume deficiency. How can we explain this?"

After Lu Chen’s explanation just now.

In the venue, everyone's eyes began to change slightly when they looked at Lu Chen.

It turns out that this Chinese doctor did not act aimlessly, but had his own ideas and reasons.

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

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

"Due to the presence of hyporeninemia, it is likely that the downstream effector of renin in this patient is the powerful and prominent angiotensin II."

"In this patient, the hypotension and inappropriate renal salt loss may be the result of insufficient tubuloglomerular feedback due to relative renin deficiency. In addition, the patient's still good GFR also reflects poor tubuloglomerular feedback, resulting in GFR dropped insufficiently!”

"Tubuloglomerular feedback is a negative feedback loop that maintains the internal environment. When the salt concentration at the end of the ascending branch of the medullary loop increases abnormally, the macula densa cells will inform the changes, causing vasoconstriction of the afferent arteriole and a decrease in GFR, thus limiting the distal Small tube salt loss..."

…

To a layman, Lu Chen's explanation was like listening to a book from heaven.

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

Many professors looked at Lu Chen with extremely surprised expressions.

The clinical thinking of this Chinese doctor has reached the level of proficiency!

At this time, the doctor in charge of the bed was stunned on the rostrum.

Every word Lu Chen said was something he had never thought of before.

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

"Then the patient has been in a state of hypovolemia. Why is the blood sodium concentration maintained at the high limit of normal?"

The bed doctor asked his last question.

These questions are just like students asking their teachers, they are simply asking for advice.

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

"For this patient, his adrenocorticosteroid function is normal, but he also has hyperkalemia and low basal TTKG, indicating insufficient potassium excretion. Considering that the patient has a history of unilateral kidney and adrenalectomy, and has a high risk for blood kidney The activity of renin is relatively low, so I fully suspect that it is a relative deficiency of renin and aldosterone.”

…

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

Everyone was recalling Lu Chen's words.

Even viewers watching 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 them?

A problem that even so many Professor Mayo couldn't solve was actually solved by a little-known doctor?

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

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

It wasn't until Lu Chen sat back down in his seat, the doctor in charge of the bed, that he came back to his senses.

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

His words no longer contained the arrogance he used to treat Lu Chen before. UU reading www.uukanshu.net

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

Scholars are sometimes very naive. They have a persistence in knowledge and truth that ordinary people cannot believe.

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

"Holy shit, 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 Lu Chen was just here to show his face.

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

And he gave a diagnosis that no one had thought of, and it made sense!

This kind of case discussion shocks everyone much more than surgery.

The surgical operation is done with familiarity.

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

Lu Chen just smiled slightly.

The system is still awesome!

What he is looking forward to most is the gratitude he will receive next.

Sure enough, after a while.

The system prompts rang one after another.

"Congratulations, receiving a thank you from Rogers Lambert is worth +100!"

"Congratulations, a thank you from Agathe Parsons is worth +100!"

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

"..."

The system prompts keep jumping.

Everyone present and watching on the live broadcast platform all contributed some gratitude points to Lu Chen.

Although this is a professional academic live broadcast with viewing restrictions, and the number of people watching the live broadcast is not large, the total number of people watching it worldwide is tens of thousands!

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

"Earn gratitude points to reach the upper limit and open the next level of shopping mall!"