Chapter 841: A Speech that Amazed the World

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

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

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

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

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

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

"Don't tell me, as far as I know, 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, but also some surgical simulation cases."

Lu Chen understood. .

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

Mayo is also generous, holding such meetings every quarter.

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

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

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

"He is Mayo's boss?" Lu Chen asked in confusion.

But why does the boss attend such an academic conference?

"He is also a doctor!" Yu Weiguang whispered, "Mayo's CEO rotates every five years and is selected from clinical doctors. So when Mayo formulates various policies, it will fully consider the ideas of doctors and will not make decisions on impulse."

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

Unlike some hospital leaders, they are laymen who are not even medical professionals.

Then 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 am really moved now. If possible, I hope to apply for Mayo Fellowship with you." Yu Weiguang sighed.

After feeling this pure medical environment, it is difficult for anyone to be willing to leave.

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

Ordinary people can't afford the medical expenses at all.

...

With the speech of Mayo CEO, the quarterly case discussion began.

Although it is broadcast live simultaneously by major media around the world, Mayo does not pay much attention to etiquette.

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

Similar to the previous procedures, the attending physician first conducted and reported the condition.

Then questions were raised and answered by experts, and finally it was time for free questions and answers.

"The case discussion has begun."

Yu Weiguang whispered.

Lu Chen also focused his attention on the huge projection screen in the venue.

The first case.

The patient is a 49-year-old woman.

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

The patient had a history of obesity and had undergone gastric banding.

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 the operation, blood potassium and blood pressure were normal.

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

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

After the case was presented, the attending physician asked three questions.

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

"Second, what is the diagnosis of the patient?"

"Third, what is the next treatment plan?"

...

Lu Chen was overwhelmed after reading the entire case.

There were more than 20 pages of A4 paper just for the patient's auxiliary examinations and test reports.

Lu Chen had never seen such a complicated condition of this patient before.

"Oh my god, I am dizzy after reading this patient's information!"

Yu Weiguang looked embarrassed.

The case was written in English, and it would take him a lot of effort to really understand it.

Lu Chen had no difficulty reading it because he had the "Literature Reading" skill card.

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

After the description of the attending physician, he still didn't understand anything.

However, the three questions of the attending physician were actually a series of related questions.

Only by finding out the cause of hyperkalemia can we finally diagnose and decide on the next treatment plan.

Solve one problem, and the next problem will be solved.

About ten minutes later.

The first Mayo local doctor began to speak.

The first topic was the analysis of the cause of hyperkalemia.

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

Worthy of being a Mayo doctor!

Even in such a complex case, we can accurately find the analytical breakthrough at the first time.

As long as it is high potassium, there are only a few reasons.

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

Lu Chen had met several of these doctors, and they were all leading figures in the cardiology and endocrinology departments.

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

However, in this patient, her renal function was acceptable, so renal failure could not explain her persistent hyperkalemia.

"When the kidneys have adequate glomerular filtration rate, increased transport of sodium and water by the distal tubules will produce an electrically gradient and dilutive tubular fluid that promotes potassium excretion."

However, although this patient had unilateral kidney removed, his renal clearance function still remained good.

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

As for hypoaldosteronism, there is no significant decrease in renin activity or aldosterone concentration in the patient's blood tests.

Therefore, high potassium caused by hypoaldosteronism has been ruled out for the time being!

…

Everyone present was a little confused!

A comprehensive analysis of the causes of hyperkalemia.

Finally, all causes were eliminated.

No wonder this patient was transferred to Mayo!

Cases of this difficulty have almost reached the ceiling level.

For a time, the entire conference hall fell into deep thought.

"Damn it, I think the analysis of the previous professors is already very good!" Yu Weiguang came to Lu Chen's side and said, "I didn't expect them to be wrong too, so what other reasons are left?"

Lu Chen frowned.

According to his current knowledge base, he was also unable to analyze the cause of the patient's hyperkalemia.

However, he has systematic help.

The current causes of hyperkalemia are the ones mentioned above.

That would be easy!

Lu Chen put all possible diagnoses in the system and went through them.

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

Lu Chen was really afraid that it was some kind of rare disease, something he had never seen before.

Then I am really useless!

Even if there is a system, it is difficult for a clever woman to make a meal without straw.

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

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

…

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

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

Why this diagnosis?

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

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

"nothing."

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

If he stands up and makes an opinion at this time, he must give corresponding reasons.

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

"Why exactly is this diagnosis?"

Lu Chen was constantly thinking about it in his mind.

It is really not an easy task to overturn all your previous thoughts and find reasons that are consistent with system diagnosis.

…

Mayo case discussion venue.

Just the first case of "hyperkalemia" caused everyone to discuss it.

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

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

If there are no more constructive suggestions, this discussion will have to be abandoned.

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

I'm looking forward to a professor who can give a different explanation for the cause of high potassium.

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

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

The doctor in charge of the bed immediately stopped and looked towards the person who raised his hand with joy in his heart.

But then, the smile on his face dimmed again.

A Chinese doctor?

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

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

The venue staff quickly handed the microphone to Lu Chen.

"I'll go, Lu Chen, you're so awesome!" Yu Weiguang looked surprised when he saw Lu Chen standing up, "This is a good opportunity to show your face, it doesn't matter even if you say the wrong thing, just tell me your reasons Just say enough!”

"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 a rule of the venue, and it also facilitated him to earn thank you points.

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

Lu Chen groaned, and after thinking about it just now, he had a clue in his mind.

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

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

"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 to 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!

When Lu Chen heard the doctor's question, he thought for a moment and continued: "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 GFR remained good 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, thereby 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!"