Sun Lien arrived at the ward with Hu Chunbo. As soon as he entered the ward, Hu Chunbo stopped the invasive medical examination and treatment of Cao Zhiquan.

Yes, even the treatment was stopped. Hu Chunbo, with a very unreasonable and arrogant attitude, forcibly asked the nurse who was about to hang up the water to stop what he was doing first.

If CJD can indeed be diagnosed, then it is excusable to stop treatment – a disease with a 100% mortality rate, a 90% mortality rate within a year of onset, doctors have no weapons at their disposal to fight the disease.

But Cao Zhiquan has not yet been diagnosed.

"This patient is highly suspicious of CJD, you should take precautions before coming in. Hu Chunbo roughly explained, and didn't care whether the nurses heard what he was saying clearly, so he walked to Cao Zhiquan's side, then picked up a pair of gloves from the cart and pressed them towards Cao Zhiquan's eye sockets.

"I was able to open my eyes, but I didn't react otherwise. After all, Hu Chunbo is a professional doctor in the gods, and the nurses hesitantly walked out of the ward, and he basically finished the physical examination, and came to the conclusion - "There is a slight stiffness of the neck, which is immobile silence." ”

"I've already confirmed this. Sun Lien nodded, and then asked, "Are you sure this is CJD......?

"Highly suspicious, and almost certain. Hu Chunbo interrupted Sun Lien's words, "Other diseases that can cause inactive silence will not progress so quickly." ”

In Hu Chunbo's view, there are only two possibilities for Cao Zhiquan's illness. Either he is a CJD patient, or Cao Zhiquan has symptoms that are almost identical to CJD, but there is also a VGKC (complex antibody-associated limbic encephalitis).

"I understand the truth...... In addition to the nurse and Cao Zhiquan in the ward, there is also Zhou Ce, who has never left. He interrupted the conversation between Hu Chunbo and Sun Lien just right, "Can anyone explain to me what CJD is?

Hu Chunbo's instructions in the ward were too imposing and a little too familiar, and the nurses only thought that this was probably a doctor who came from the gods to consult, and listened to the instructions of others, put down the work in hand and left. But Zhou Ce was very sure that Hu Chunbo was not the fourth hospital's own physician.

A total of 17 doctors from the Department of Neurology of the four hospitals are available for consultation, including one chief physician and two deputy chief physicians. And he knew all seventeen of them.

"CJD, you don't even know?" Hu Chunbo glanced at Zhou Ce in some surprise, then turned to Sun Lien and asked, "You still recruit such an old standard trainee?"

"Ahem...... That ......" Sun Lien didn't need to look at it to know that the expression on Zhou Ce's face was not very good-looking, and quickly explained, "Doctor Zhou is the chief of our treatment team, and he is from nephrology. ”

"Oh, that's what I see. "Although Hu Chunbo's mouth is sometimes faster than his brain, as long as his brain turns, he is also very bright. He explained with a smile, "Dr. Zhou, it's normal for you to stay in your kidneys for a long time and not know - CJD is a truly rare disease, with an annual incidence rate of about 0.4 per million. However, there is another similar disease you should have heard of - VGKC. ”

Zhou Ce showed a somewhat confused expression, he shook his head after thinking about it, "This...... I haven't heard much of it. ”

Hu Chunbo was stunned for a moment, and then smiled bitterly, "I just thought that VGKC is related to immunity, but I forgot that there are not too many reports of this disease at present." ”

VGKC is a rare form of limbic encephalitis associated with immune, and most patients present with the same MRI image as CJD, the ribbon sign. In addition, there are symptoms such as triphasic wave EEG and subacute dementia that are consistent with CJD patients. Even the positive symptoms of 14-3-3 protein in cerebrospinal fluid are exactly the same.

It can be said that VGKC and CJD are almost identical twins on the outside. But there is still a huge difference between them.

VGKC can be treated.

As one of the autoimmune diseases, patients with VGKC are often able to achieve quite good results after receiving hormone pulse therapy and plasmapheresis. After taking corticosteroid drugs regularly, many patients with VGKC can even recover to a completely acceptable level.

However, CJD is different, and all patients who have CJD die without exception. The mortality rate of CJD patients is as high as 90% within one year of onset, and the longest confirmed survival time of CJD patients after onset is only eight years.

"CJD, it's Creutzfeldt-Jakob disease. Hu Chunbo did not continue to speak, and Sun Lien stood up and was responsible for explaining to Zhou Ce what CJD was. "If this name still sounds a little unfamiliar, then you must have heard of a special species of it - mad cow disease. ”

Creutzfeldt-Jakob disease is a fatal infectious disease caused by prion protein particles and prions. At the same time, it is also a zoonotic disease. The most representative of them is the mad cow disease that originated in the British industrial cattle farms in the 80s.

As a new pathogen that has only been discovered in the last 60 years, prions are different from any pathogenic body that has been traditionally known as a disease - it does not contain any DNA or RNA structure, and the prion is essentially a protein particle. However, due to the fact that prions have not been discovered for too long, and their size is smaller than the smallest known viruses (about 30~50 nanometers), human understanding of prions is still very superficial.

Although little is known about this protein particle, doctors and scientists have identified the characteristics of at least one of the classes of prions.

PrPsc prion viruses mainly attack the nervous system of animals, and prions infect cranial nerves and cause the death of a large number of nerve cells. When these nerve cells die, they tend to leave a large number of cavities in the brain tissue, making the brain tissue look like a sponge. For this reason, prion diseases are also known as infectious spongiform encephalopathy (TSEs). These include mad cow disease (BSE) that infects cattle and humans, scrapie in sheep and mice, and Kuru and Creutzfeldt-Jakob disease, which can be transmitted and even inherited from person to person.

Zhou Ce suddenly realized that he shook his head again, "This shouldn't be...... The patient himself worked on a construction site, and he certainly had never been to the UK, let alone eaten British beef in China, which should be banned from being imported in China. ”

"The ban on imports of British beef was lifted in June '19. And it's not necessarily mad cow disease...... He may also be a patient with hereditary, sporadic, or iatrogenic Creutzfeldt-Jakob disease. Hu Chunbo answered Zhou Ce's question very perfectly, and then he began to verify his guess by asking Sun Lien questions, "Has the patient undergone neurosurgery? Has the cornea been transplanted, and has his parents ever had dementia?"

"Nope. Sun Lien shook his head, he had asked the patient's family these questions. However, there may be some problems with genetic diseases - Cao Zhiquan's father died on the battlefield to resist US aggression and aid Korea, and his mother died of liver cancer. Cao Zhiquan's father needless to say, his mother was not yet 50 years old when she died.

"That's trouble. Hu Chunbo sighed, "If it's not hereditary or iatrogenic, it's sporadic." ”

Diagnosis of sporadic Creutzfeldt-Jakob disease...... Strictly speaking, it's actually kind of funny.

First of all, there is only one diagnostic option for Creutzfeldt-Jakob disease, which is a brain biopsy or an autopsy of brain tissue. In general, unless the spongy brain is seen under the microscope, doctors can at best be "highly suspicious" and unable to "diagnose" Creutzfeldt-Jakob disease.

Second, sporadic CJD is Creutzfeldt-Jakob disease with no source at all and no clues at all. No one knows exactly how the patients themselves were infected with prions – some patients had changes in their own gene loci and thus missynthesized the PrPsc virus in their brain tissue. Some patients have no changes at all, but they still show symptoms of Creutzfeldt-Jakob disease and die quickly. However, due to the wishes of the patient's family, it is unlikely that a brain biopsy or autopsy can be performed on a patient with a high suspicion of Creutzfeldt-Jakob disease in China. In the past ten years, there have been only two "highly suspected CJD patients" who have undergone autopsies and finally been diagnosed.

It is precisely because of this special phenomenon that doctors will treat "high suspicion" as a "diagnosis" of CJD in clinical practice.

No way, the conditions for diagnosis are too harsh.

In a way, doctors themselves don't want to be completely diagnosed with CJD. The reason is also very simple, there is no cure for this disease.

The nature of prions determines that they are immune to all drugs. There is no treatment that can stop the virus from replicating itself in the patient's brain and killing other nerve cells. Even radiation has no effect – in fact, it is precisely because humans have been able to confirm that the virus itself does not contain genetic material such as DNA and RNA. Early scientists irradiated the brain tissue of sheep suffering from pruritus and then inoculated it again with other healthy sheep. The vaccinated sheep also began to develop the disease, which led to the bold speculation that "the pathogen does not contain genetic material".

Chemical drugs are ineffective, biological drugs are ineffective, radiation and other means are ineffective, and more traditional neurosurgery is even less effective - protein particles with a size of less than 50 nanometers, even if they really develop nanorobots in science fiction, I am afraid that they may not be able to deal with it.

Take 10,000 steps back, even if drugs and treatments suddenly appear now that can stop prions from replicating. Cao Zhiquan's condition will not improve in the slightest, at most, his condition will no longer progress. Nerve cells that have died cannot be reborn.

In order to cure CJD patients, it is necessary to have the means to completely kill the virus, and at the same time, it is necessary to have the ability to promote the regeneration of nerve cells.

In other words, at least two Nobel Prizes in medicine can be put together to save Cao Zhiquan's life.

Sun Lien was silent for a while, looked at Cao Zhiquan lying on the bed, and shook his head gently. 1603439858