In the outpatient clinic of the Department of Rheumatology and Immunology, it is particularly popular today.

The most popular animal in the zoo is the panda, especially when the panda starts to eat, visitors to the zoo will gather from all directions, and then hold their mobile phones together, watching the black, white and white fat man in front of him gnaw on apples or special nests.

And today's Rheumatology and Immunology Department of the Fourth Central Hospital...... It is probably similar to a giant panda standing on one leg to play skipping rope all the time, and he also speaks fluently, and smoothly says a part of the mouth filling in "Reporting the Name of the Dish".

They came to see the excitement, to see a "foreign doctor" wearing a white coat to treat people.

Speaking of foreign doctors, the first name that can appear in the minds of Chinese people must be Bethune. The story of that great internationalist warrior who resolutely came to China in the most difficult period and stayed here forever is known to almost every Chinese.

With Comrade Bethune's foundation, the white-skinned Dr. Pascal suddenly received the buff of "favorability improvement", and because some professional terms need to be specially explained, and at the same time, it is necessary to use the right to comply with prescriptions and facilitate the understanding of patients, and many other reasons, Dr. Pascal also specially selected a young doctor with excellent English proficiency to be the interpreter when Dr. Pascal was on the spot.

There was an increase in favorability, there was an interpreter, and Dr. Pascal's American medical habits were used to talk to patients about their illness slowly, and he tried to explain the cause in as much detail as possible. This made Dr. Pascal instantly popular during the week of emergency department lockdown, and became the most sought-after doctor in the outpatient department of the Fourth Central Hospital.

Many people in Ningyuan have heard such news, and there is a foreign doctor with a good attitude and high level in the Fourth Central Hospital!

Dr. Pascal has been to China many times through the MSF program and often treats patients in China. But in the past, it was more often him and other doctors who formed a treatment team and took the initiative to go to places with inconvenient transportation. Although everyone is very welcoming, after all, the number of people in the small village with difficult transportation is limited, and even if everyone comes together, it is only at the level that they can see it all in a day or two. Ke Ningyuan...... It's a big city with a population of several million.

Since Sun Lien and Xu Yourong were quarantined for observation, Dr. Pascal began his outpatient life. On the first day, everyone was still unsure of his path. Few patients come to see him, and occasionally a few are patients who are unsure of other doctors or want a second advice.

The next day, some well-informed patients gradually came to the door. Pascal's level is indeed good, and the treatment plan for these patients is well arranged. But more importantly, he has more time and is used to spending more time with patients. The number of patients that doctors in China have to see is so great that even if a patient gets less than five minutes before and after, there will still be a lot of queues. Sometimes, there are even cases where the first morning is registered, and when the clinic closes in the afternoon, there are still more than 100 people who have not been treated.

On the third day, more patients began to choose to hang in Prof. Pascal's outpatient clinic, and from this day on, Prof. Pascal's lunch time began to have the same quantum uncertainty as other doctors. He could only look down and nibble on his wife's handmade sandwich while he had finished reading the previous patient and the next patient was about to enter the room.

Today is Dr. Pascal's eighth day of outpatient visits.

Dr. Pascal rubbed his hot head, and he felt like he was back in college this week. Every patient's situation is different, and everyone's response to treatment is different. He treats dozens or hundreds of different patients in a day and develops the right treatment plan for them. This kind of workload would not have been possible with his original style of treatment. As a result, he also began to gradually change his work style, and began to move closer to the Chinese doctors who he did not agree with before, and used the fastest speed and the most direct style to deal with every patient who came to him.

"Consultation?" The translation doctor in charge of assisting him raised his eyebrows, turned his head and asked, "Lao Pa, I want you to go to the emergency department......

"I'll be there soon!" Dr. Pascal stood up and sprinted toward the emergency room. In all fairness, Lao Pa has performed very well. It's just that this kind of outpatient clinic with no end in sight really makes him a little scared. In the name of consultation, even if it is just to go out for a walk, it is also a relaxation for him.

"What is this for?" The patient who was still waiting to see a doctor at the door stared curiously at Pascal who was running wildly, "What is the disease of that person inside?

"Hmm......" Dr. Pascal looked at Yang Jianqiang's test results, frowned for a long time and shook his head, "His low CD4 should be mainly due to the effect of immunosuppressants." It's not caused by an unknown disease. ”

Sun Lien had expected this answer for a long time, and Yang Jianqiang is now doing new CT and MRI tests. The main reason why he invited Dr. Pascal to come for the consultation was actually to see if there was room for further adjustment of the triple immunosuppression regimen that Yang Jianqiang was currently using. If Yang Jianqiang's immune system can be increased within the safety of the transplanted bone marrow, it is possible to use his own immune system to label the unknown pathogen causing the disease.

"This ...... Hardly possible. Dr. Pascal directly poured cold water on Sun Lien's whim, "The reason why such a combined immunosuppression regimen is used in clinical practice is because the inhibition effect of a single drug is not ideal. To achieve the level of inhibition we want, the dosage of a single drug becomes very large. This will undoubtedly increase the patient's chances of organ damage and other side effects. The most important reason for using a combination immunization regimen is that the effect of immunosuppression can be improved through the interaction between the three drugs. He sighed and continued to shake his head, "If the immunosuppressants are reduced or even stopped, I even think that his immune system will kill all the bone marrow cells that have been transplanted from the xenograft before it can recognize the pathogen you are looking for." It then causes a cell storm and ends up directly dying, with your patients dying of high fever and respiratory failure. ”

"But there were some changes in the patient's condition. Sun Lien specifically pointed to the column of cerebrospinal fluid pressure level, "His cerebral pressure was still normal when he was admitted to the hospital to collect cerebrospinal fluid, and after our doctor adjusted his immune regimen, he suddenly had an increase in intracranial pressure." ”

"It could be a side effect of the mycophenolate mofetil he used...... Dr. Pascal stopped suddenly, he shook his head, and dismissed his idea, "No, even if the lymphoma is squeezing the brain, it shouldn't appear so quickly." ”

One of the rare side effects of mycophenolate mofetil is that it can trigger lymphoma and nonmelanoma skin tumors. But Yang Jianqiang only started using mycophenolate mofetil 24 hours ago, and even if he was unfortunate enough to suffer from this rare side effect, the symptoms of the disease would not have appeared on him so quickly.

"His immune system is suppressed, so it won't be an allergic reaction caused by methylprednisolone. Basiliximab, on the other hand, only reacts with T cells and should not cause problems in the central nervous system. The more Dr. Pascal pondered, the more confused he became, and he even began to wonder if he had misremembered the side effects of the drugs.

According to normal logic, if condition A changes in a system, then the output of the system also changes. Then one would naturally assume that the change in outcome b is triggered by condition a. But based on the available knowledge, a change in condition A is absolutely impossible to trigger such a distinction. It's no wonder that Dr. Pascal is confused. It's like cooking a dish with only salt, but the dish tastes sweet.

"I'm thinking...... Is it because after we adjusted his inhibition program, the new inhibition program is not as effective as the previous one? Sun Lien slowly voiced his conjecture, "This makes his immune system a little more active than before." And this is the reason for the change in symptoms before and after?"

"If your guess is correct...... Dr. Pascal gasped, "then he's probably got a serious infection." ”

The emergency CT chart is out. During this examination, the imaging department found eight areas of low-density edema, which are also eight shadows.

"It's definitely not a tumor. Nor is it bacterial encephalitis. The radiologist and Liu Pingchuan, who came for consultation, agreed. These eight areas of slight edema are located relatively close to the ventricles, which causes a more pronounced change in cerebrospinal fluid pressure.

"Anyway, this is at least the beginning. Liu Pingchuan patted Sun Lien on the shoulder, "What are you going to do with the diagnosis later?"

Sun Lien frowned and thought for a long time, then suddenly asked Dr. Pascal, "What diseases may be transmitted by bone marrow transplantation?"