I Can See Health

   Chapter 863 The future of China (the fourth bigger chapter!)

   Chapter 859 The future of China

   The First Affiliated Hospital of Huaxia Kyoto.

   Town Hall.

   Looking at the continuously playing coronary angiography images, everyone fell into contemplation.

   Even someone as knowledgeable as Qin Sifeng didn't have any clues 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 this patient's blood vessels, in addition to local stenosis, are also dilated!

   "Everyone can answer any opinions, don't be afraid of being wrong, you can say anything if you have an idea."

   On the podium, Kebed said to the crowd with a smile.

   "This case was the result of a discussion between me and a Huaxia doctor. He is also present today."

   Yao Jie's heart moved when she heard this.

   This American doctor should be talking about Brother Lu Chen, right?

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

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

   Suddenly, Yao Jie said as a boy.

   "How do you know?" Yao Jie frowned.

  Although Lu Chen stayed in Kyoto, this happened many years ago.

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

   At that time, Wu Lang pursued Yao Jie, but Lu Chen suddenly appeared, which made him lose his thoughts.

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

   His heart started to get restless again.

"I see, if you want to ask Lu Chen, he should know the diagnosis of this case." Wu Lang suddenly whispered, "As your senior brother, I think he should tell you the answer. To perform in front of the big leaders, it must be quite brilliant."

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

   "Hmph, I wouldn't do such a thing!" Yao Jie immediately rejected Wu Lang, "This is equivalent to deception, whether Brother Lu Chen wants it or not, I definitely won't ask him!"

"Hey, this case is actually something we haven't seen." Wu Lang smiled disdainfully, "A rare disease, if I see it once, I can definitely diagnose it next time. Mayo sees this rare disease a lot. Actually, it doesn't matter after all."

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

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

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

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

  …

   At the scene, there was finally a doctor in charge of Huaxia, who bravely stood up 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 vasodilation in the stenosis."

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

   "No one else answered again?"

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

   Then, an English text appeared on the projector on the podium.

   Translated into Chinese, it is "coronary dilation"!

"Yes, this disease is actually very rare, it's called coronary artery dilatation." Kebed continued, "I checked Mayo's own database, and finally found the name of the disease. Its incidence in Chinese people is not high, mainly Still in Europe and the United States and other places, the incidence rate of each study is different, about 0.02%."

   Hearing Kebed's words, the Huaxia doctors below began to check relevant information on the Internet.

   With Kebed's explanation, and everyone's own understanding of the situation.

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

   Coronary ectasia, English name CAE.

  Kebed continued:

"In short, it is actually an abnormal expansion of the subepicardial coronary artery. The diameter of the lumen at the dilation exceeds 1.5 times the diameter of the adjacent normal segment, and if the diameter exceeds the diameter of the adjacent normal segment by more than 2 times the limitation The dilation is called a coronary artery aneurysm (CAA)."

   "If the diameter of the pipe 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. The second is the left anterior descending coronary artery (LAD), the left circumflex coronary artery (LCX), and the left coronary artery is often segmental, and the most Infrequently involving the left main (LM) of the coronary arteries."

   "The case I'm introducing to you today, more precisely, should be of CAEI grade of coronary artery dilatation."

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

   Really a pretty rare case!

   After what Kebed said, this disease is now simpler.

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

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

   "If you have any doubts about this case, 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.

   Wu Lang's level, she knows.

   He has published several SCI papers in China, and he is a little clever, but when he encounters such a large-scale academic conference, what other good opinions can he have?

   "Okay, man, please answer."

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

   Afterwards, the leaders of Yang Feng, Qin Sifeng and other institutes immediately turned their attention to this young doctoral student.

   Being stared at by many big coffees, Wu Lang was also a little scared.

   But as soon as he thought that his speech would make the leader aware, he suppressed his inner panic.

"Professor Kebed, what I actually want to ask is about the grading of coronary artery ectasia you mentioned." Wu Lang said slowly, "This patient is very serious, but the grade is only grade I, so grade II cannot grow into Beaded like candied haws?"

  Kebed may not understand what a candied fruit is, but someone immediately explained it, and he understood.

Afterwards, Kebed smiled: "Actually, CAE grades are arranged in descending order of severity, grade I is diffuse dilation of double or triple vessels, grade II is diffuse dilatation of single vessel and localized dilation of another vessel. Grade III is diffuse dilatation of a single vessel, and grade IV is local segmental dilatation.”

   "This...Thank you professor for your explanation."

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

   He never imagined that this classification put the heaviest in the front and the lightest in the back.

   is inverse to 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 oolong joke.

   Wu Lang hurriedly sat down.

   Yao Jie 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 calmly and said: "You Huaxia have a saying, those who don't know are innocent. This young student did a good job just now. Otherwise, I wouldn't have a chance to tell everyone about this classification."

   When Wu Lang heard this, his face turned red again.

   Why does he still "sarcastic" him?

   "Do you have any other questions about this disease?" Kebed continued, "If not..."

   At this moment, Yao Jie suddenly raised her hand.

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

   Yao Jie stood up slowly, she glanced at Lu Chen secretly, and then slowly shifted her gaze to Kebed.

   At this time, Lu Chen also found Yao Jie in the front row.

   He was also very surprised. He didn't expect to meet Yao Jie again on this occasion.

  …

   Yao Jie looked at Kebed and slowly expressed her doubts.

   "Kebed, from what you just described, I know the manifestations of this coronary artery disease, but in the end, 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 for causing CAE, and the underlying pathogenesis includes extracellular matrix degradation, activation of systemic and local inflammatory processes, changes in nitric oxide (NO) metabolic processes, and the renin-angiotensin-aldosterone system. (RAAS) activation, genetic factors, and interventional associations."

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

   "Atherosclerosis?" Yao Jie felt even more surprised, "Isn't atherosclerosis leading to stenosis of blood vessels, why does it also lead to coronary dilation?"

   This question also asked the voice of everyone present.

   Expansion and stenosis are opposite manifestations.

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

Kebed explained calmly: "Atherosclerosis involves the intima, media, and adventitia, which promotes 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 action of arteriosclerosis, local inflammation, vascular remodeling, etc., it leads to a complex situation of dilation, stenosis, and coexistence of thrombus."

  CAE is divided into congenital and acquired, and congenital is less common.

Atherosclerosis is the most common cause of acquired CAE, accounting for 50% of adult CAE.

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

  Male, hyperlipidemia, hypertension, and smoking were clear risk factors.

   "If you describe the changes in detail, it won't be clear in a short time." Kebed smiled at Yao Jie, "If you are interested, we will upload this medical record for everyone to study."

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

  Kebed was about to withdraw. Unexpectedly, Yao Jie spoke up again, then smiled and nodded, "You ask."

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

Kebed glanced at Yao Jie with admiration, "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. and sudden death, 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 in such a lesion?"

  It is usually said that the stenosis caused by atherosclerosis requires stenting.

   However, this patient also had dilation.

Kebed shook his head: "Dilated arteries are prone to thrombosis. In the face of such lesions, conventional stent implantation is obviously more risky. Through research, we believe that coil embolization can be performed on the dilated area, just like the treatment of cerebral aneurysms, but The risk remains high. There is not enough research to guide intervention, and coronary artery bypass grafting (CABG) is the first choice."

   Having said that, Kebed glanced at Yao Jie, indicating that she had any questions to continue asking.

   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, you can think of these questions at the first time, and many of them are critical. The problem is not that simple."

   Hearing Kebed's praise, Yao Jie smiled shyly.

   aside, Qin Sifeng's face was full of smiles.

  This is his student!

  Being in front of the leader today really gave him a face!

   Everyone thought that this case was over, but what was unexpected is that Kebed still has content to share with you.

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

   This time, more people raised their hands to answer the question.

   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 antibodies, two antiplatelet drugs, aspirin and clopidogrel, and then supplemented with lipid-lowering drugs."

  Kebed shook his head: "The idea is good, but a little one-sided, do you have any other opinions?"

   Yao Jie kept thinking about this question, she immediately raised her hand.

   "Okay, this lady please continue to answer." Seeing Yao Jie raising his hand again, Kebed called her name immediately.

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

   "I felt that 'tertiary antibodies' could be used to maintain treatment!"

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

   "How to use the three antibodies?" Kebed asked with a smile.

   Yao Jie continued: "I have never seen such patients, but they can be compared to patients with coronary heart disease and atrial fibrillation. These patients also need to use tertiary antibodies in the unstable period."

   "That is, stop clopidogrel after 1 month, continue to use aspirin and warfarin, and control the International Normalized Ratio (INR) between 2.0 and 3.0 with multiple reviews."

   "In addition, while applying the 'tertiary antibody', the dosage of statins should be strengthened. If the patient's symptoms can be controlled smoothly, coronary artery bypass grafting is also possible."

   As soon as he finished speaking, Kebed gave Yao Jie another thumbs up.

   "Nice to know how to treat a patient by analogy! You're right, it's roughly the same as the treatment we chose."

   The PTT screen on the screen continues to switch.

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

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

   At this moment, everyone present had to look at this little girl Yao Jie with admiration.

   Agile clinical thinking mode, not afraid of facing danger from top Mayo professors.

   Even Yang Feng, the director of Cardiology University, was asking who this girl was from.

   The one with the brightest smile right now is Qin Sifeng!

  Today Yao Jie gave him too many surprises.

  …

   on stage.

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

  Unconsciously, the little girl who used to follow him to round the house has grown up!

  Lu Chen couldn't help sighing in his heart.

   Over the years, not only is he growing up, but the group of people around him are also growing.

  Gu Xinyue, Ke Yue, Wang Zihao, Ke Yue, etc., and even Fan Zhiping, who is a graduate student, are continuing to further their studies and study!

  Perhaps, the future of medicine will be accompanied by so many friends and not so lonely.

  Perhaps, in the future, Huaxia's medical career will definitely be better because of the existence of so many young talents!

   Yesterday, I updated 1w words, asking for votes and subscriptions, is it not too much?

   (end of this chapter)