I Can See Health

The First Affiliated Hospital of Kyoto, China.

Great Hall.

Everyone was lost in thought as they looked at the coronary angiography images that were constantly playing in front of them.

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

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

Normal myocardial infarction blood vessels have local stenosis.

But this patient's blood vessels, in addition to local stenosis, were also dilated!

"Everyone can answer whatever opinions they have. Don't be afraid of making mistakes. If you have any ideas, you can speak up."

On the rostrum, Kebed smiled and said to everyone.

"This case was the result of a discussion between me and a Chinese doctor, and he is also present today."

When Yao Jie heard this, her heart moved.

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

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

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

Suddenly, Yao Jie spoke up as a boy.

"How do you know?" Yao Jie frowned.

Although Lu Chen had stayed in Kyoto, it was many years ago.

"I definitely remember it." Wu Lang curled 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 stop thinking about it.

However, as Lu Chen left, he and Yao Jie both stayed in Kyoto.

He began to feel restless inside again.

"I see, if you don't ask Lu Chen, he should know the diagnosis of this case." Wu Lang suddenly whispered, "As your senior brother, I think he should be able to tell you the answer. If you can do this in these If you perform in front of a big leader, you will definitely be outstanding.”

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

"Hmph, I won't do such a thing!" Yao Jie rejected Wu Lang straight away, "This is tantamount to cheating. Regardless of whether Senior Brother Lu Chen wants it or not, I will definitely not ask him!"

"Hey, we have never seen this case before." Wu Lang smiled disdainfully, "It's a rare disease. If I see it once, I can definitely diagnose it the next time. Mayo is a rare disease like this that is often seen. Actually, it’s nothing in the end.”

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

Wu Lang realized that his instigation had failed, shrugged and stopped talking.

However, although Yao Jie did not ask Lu Chen for the answer, she thought about it in her heart.

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

…

At the scene, a Chinese attending doctor finally 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 blood vessel stenosis, but this patient also has blood vessel dilation in the blood vessel stenosis."

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

"No one else answered?"

Kebed looked around and saw no one raised their hands, so he smiled and said, "Okay, then I won't waste any more time and start announcing the answers."

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

Translated into Chinese, it is "coronary ectasia"!

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

After hearing Kebed's words, the Chinese doctors below began to look up relevant information online.

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

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

Coronary artery ectasia, also known as CAE in English.

Kebed continued:

"In short, it is actually an abnormal dilation of the subepicardial coronary artery. The diameter of the lumen at the dilation site exceeds 1.5 times the diameter of the adjacent normal segment. If the diameter exceeds more than 2 times the diameter of the adjacent normal segment, there are limitations. The dilation is called a coronary artery aneurysm (CAA)."

"If the diameter of the tube exceeds the normal segment diameter by more than 4 times, it is giant CAA."

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

“The case I’m introducing to you today, more accurately, should be CAEI grade coronary artery ectasia.”

As soon as he finished speaking, everyone started talking.

It is indeed a quite rare case!

After what Kebed said, this disease is now simpler.

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

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

"If you have any questions about this case, you can ask!" 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 several SCI papers in China and is a bit clever, but when it comes to such a large academic conference, what other good opinions can he have?

"Okay, this gentleman, please answer."

A staff member immediately handed the microphone to Wu Lang.

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

Being stared at by many big shots, Wu Lang was also a little frightened.

But when he thought that speaking would make his leader aware of him, he suppressed his inner panic.

"Professor Kebed, what I want to ask is actually about the coronary artery ectasia grading issue you mentioned." Wu Lang said slowly, "This patient is very serious, but the grading is only grade I, and grade II must not grow into Candied haws kind of beads?”

Kebed may not quite understand what candied haws on a stick is, but someone on the side immediately explained it to him, and he understood.

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

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

After hearing Kebed's words, Wu Lang rubbed the back of his head in embarrassment.

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

It is inversely related to the 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 softly.

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

On the stage, Kebed smiled magnanimously and calmly and said: "You Chinese have a saying, those who don't know are not guilty. This young student just performed very well. Otherwise, I would not have the chance to tell everyone about this classification."

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

Why does this sound like "sarcasm" to him?

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

At this time, Yao Jie suddenly raised his hand.

"Okay, madam, you answer." Kebed pointed to Yao Jie, who was sitting in the front row.

Yao Jie stood up slowly. She glanced at Lu Chen secretly, and then slowly moved her gaze towards Kebed.

At this time, 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 such an occasion.

…

Yao Jie looked at Kebed and slowly expressed her doubts.

"Kebed, from what you just described, I understand 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 pathophysiological level, which is of some value.

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

"You may have also seen reports of myocardial infarction in children, many of which are caused by 'Kawasaki disease', which is also 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, "Isn't atherosclerosis always leading to blood vessel stenosis? How come it also leads to coronary artery dilation?"

This question also asked the thoughts of everyone present.

Expansion and stenosis are opposite expressions.

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

Kebed explained calmly: "Atherosclerosis involves the intima, media, and adventitia, promoting proteolysis of the extracellular matrix, while enhancing local inflammatory responses, destroying blood vessel elasticity, and reducing the pressure of the blood vessel wall on blood flow. tolerance, leading to vascular remodeling..."

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

CAE is divided into congenital and acquired forms, with congenital forms being less common.

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

The most common cause of CAE in children is Kawasaki disease, but there are also infectious diseases (sepsis, fungal emboli, syphilis, Lyme disease), connective tissue diseases (Marfan syndrome, Ehlers-Danlos syndrome, sclerotherapy). dermatoses), drug-related, trauma and iatrogenic causes.

Male gender, hyperlipidemia, hypertension, and smoking are clear risk factors.

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

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

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

"Since they are both caused by atherosclerosis, will the symptoms of vasodilation also 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 discovered accidentally during coronary angiography. However, 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 in such a lesion?"

Generally speaking, stenosis caused by atherosclerosis requires stent placement.

However, this patient also had dilation.

Kebed shook his head: "Dilated arteries are prone to thrombosis. It is obviously risky to choose conventional stent implantation when facing this kind of disease. Through research, we believe that coil embolization can be performed on the dilated area, just like cerebral aneurysms, but The risk is still high. There is currently insufficient research to guide interventional treatment, and the first choice is coronary artery bypass grafting (CABG).”

Having said this, Kebed glanced at Yao Jie and signaled her to continue asking if she had any questions.

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

"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 issues immediately, and many of them are critical. The problem is very simple.”

Hearing Kebed's compliment, Yao Jie smiled shyly.

On the side, Qin Sifeng's face was full of smiles.

This is his student!

He really gained face in front of the leader today!

Everyone thought this case was over, but unexpectedly, Kebed had more content to share with everyone.

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

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

After some questions and answers from Yao Jie, everyone was no longer so restrained.

A senior deputy chief physician said: "I think you should take dual antiplatelet drugs, aspirin and clopidogrel, and then supplement with lipid-lowering drugs."

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

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

"Okay, madam, please continue to answer." Kebed saw Yao Jie raising her hand again and immediately called her name.

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

“I think we can take ‘three anti-antibodies’ to maintain the treatment!”

The so-called "three anti-antibodies" are the use of two antiplatelet drugs, aspirin and clopidogrel, plus warfarin (rivaroxaban) for anticoagulation.

"How to use the three resistances?" 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 patients also need to use three antibodies during the unstable period."

"That is, discontinue clopidogrel after 1 month, continue to use aspirin and warfarin, and conduct multiple reexaminations to control the international normalized ratio (INR) between 2.0 and 3.0."

"In addition, while applying the 'three antibodies', the dosage of statins should be increased. If the patient's symptoms can be controlled stably, it is okay not to undergo coronary artery bypass grafting."

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

"It's great that you actually know the treatment method for analog patients! You are right, it is basically similar to the treatment method we chose."

The PTT screen on the screen continues to switch.

The patient's treatment was revealed.

After everyone's comparison, it turned out to be similar to what Yao Jie said just now.

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

Agile clinical thinking mode and fearlessness in the face of danger from Mayo's top professors.

Even Yang Feng, director of the University of Cardiology, was asking who this girl's student was.

The one with the brightest smile now is Qin Sifeng!

Yao Jie gave him too many surprises today.

…

On stage.

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

Unknowingly, the little girl who used to follow him on ward rounds has grown up!

Lu Chen couldn't help but sigh in his heart.

Over the years, not only has he grown, but the people around him have also continued to grow.

Gu Xinyue, Ke Yue, Wang Zihao, Ke Yue, etc., and even Fan Zhiping, who came to graduate school for a long time, are constantly studying and learning!

Perhaps, in the future of medicine, with the company of so many friends, I will not be so lonely.

Perhaps, China's medical industry will be better in the future because of the presence of so many young talents!

"Brother Shen!"

"Um!"

When Shen Changqing walks on the road, whenever he meets someone he knows, he will say hello or nod to each other.

But no matter who it is.

There was no unnecessary expression on everyone's face, as if they were indifferent to everything.

To this.

Shen Changqing has become accustomed to it.

Because this is the Demon Suppression Division, an organization that maintains the stability of the Qin Dynasty. Its main responsibility is to kill monsters and monsters. Of course, there are also some other side jobs.

It can be said.

Everyone in the Demon Suppression Division has a lot of blood on their hands.

When a person is used to seeing life and death, he will become indifferent to many things.

When he first came to this world, Shen Changqing was a little uncomfortable, but he got used to it over time.

The Demon-Suppressing Division is huge.

Those who can stay in the Demon Suppressing Division are all powerful masters, or those who have the potential to become masters.

Shen Changqing belongs to the latter.

Among them, the Demon Suppressor Division is divided into two professions, one is the Guardian Envoy and the other is the Demon Slayer.

Anyone who enters the Demon Suppression Department starts from the lowest level as a demon slayer.

Then he will be promoted step by step, and he is expected to eventually become a guardian envoy.

Shen Changqing's predecessor was a trainee demon slayer in the Demon Suppression Division, and he was also the lowest level among the demon slayers.

Possessing the memory of a previous life.

He is also very familiar with the environment of the Demon-Suppressing Division. UU Reading www.uukanshu.net.

It didn't take long for Shen Changqing to stop in front of a loft.

Unlike other places in the Demon Suppressing Division that were full of chills, the attic here seemed to stand out from the crowd, showing a different kind of tranquility in the bloody Demon Suppressing Division.

At this time, the attic door was open, and occasionally people came in and out.

Shen Changqing only hesitated for a moment before stepping in.

Enter the attic.

The environment changes in vain.

The fragrance of ink mixed with the faint smell of blood hit his face, causing him to frown instinctively, but then relaxed it quickly.

There is almost no way to cleanse away the smell of blood on everyone in the Demon-Suppressing Division.

:,!