Time is another key in this case.

Tang Min's symptoms began to progress again - this morning's MRI showed signs of enlargement in the previous hypointense area. The doctors in the imaging department compared it for a long time, and then determined that the previous two low-signal areas had diated by about one millimeter.

Despite all the progress in imaging, Tang Min has not shown any discomfort at present. She was still in the same mood as usual, depressed but in okay shape. However, the progress of imaging made all the doctors who were concerned about the progress of her condition "chuckle" in their hearts.

After the hospitalization began, Tang Min received a full set of medical supervision. Even the meals she eats every day are actually adjusted and formulated by the rheumatology and immunology department and the nutrition department - they deliberately chose a combination that would not induce allergic reactions according to Tang Min's previous multiple allergic immunology assays. It may seem like a bit of a fuss, but the doctors try to avoid any discomfort — no one knows if it will worsen again.

As a result, Tang Min's symptoms began to progress again after being admitted to the hospital. And according to previous imaging records, this progress occurred after she was admitted to the fourth hospital - before she was admitted to the fourth hospital, several hypointense areas in her skull had only dilatated by 2mm in three months.

Rapid progress in a short period of time is something that requires a high level of attention. But Sun Lien and the others studied together for a whole afternoon, but they still couldn't determine what caused the progress.

"We basically haven't used medicine for her......" Zhou Ce, who was emaciated after the director's round, looked a little more haggard after studying various examinations for an afternoon. He looked at the thick examination report and the two-line medication record and groaned, "How do you think this lesion happened?

"Every day since I saw this patient, I feel like what I've learned is simply not enough. Sun Lien put down the information in hand, and then pulled his hair in pain. "What is AQP4 protein that Dr. Yuan said at noon today, I heard the teacher talk about it a few times when I was in school. What is the specific mechanism...... I'm blinded. ”

"Finally there's something you won't. Xu Yourong turned on the taunting mode on the side, and she was also a little embarrassed by the work she was responsible for—especially after just having a difficult neurosurgery. "I thought you knew everything, Team Leader Sun. ”

Sun Lien glanced at Xu Yourong with some weakness, he had long known that his basic knowledge was not strong enough. Therefore, when I was with the group, I deliberately made up for more than a year of various clinical knowledge. But this knowledge ...... Now it doesn't seem to be enough.

"I think your standards are too high for Dr. Sun. Dr. Brunn rubbed his stubble face with his hand to tickle it, and then excused Sun Lien, "Sun is just a doctor who has been practicing for less than three years, you can't expect a rookie to save the world, right? Even Hollywood knows that the real thing that can save the world is the battle-hardened elderly Marines." He put down the case in his hand, then frowned and said, "Did the patient's family give her any drugs? I didn't find anything suspicious in the records." ”

"Definitely not. Sun Lien shook his head, before entering the hospital, Professor Zhang had already communicated with Tang Min's parents. They also have no intention of seeking any "home remedies" or "miracle cures". Tang Min's parents are still very reliable on this issue - parents who have reservations about modern medicine probably won't spend a whole year taking their children to numerous hospitals.

"You'd better be sure. Dr. Brunn knocked on the table and pressed Sun Lien, "If the child's parents haven't given her any drugs, then we can only suspect that mannitol or MRI have had a bad effect on her—she hasn't used contrast agents yet." ”

Yuan Ping'an did not participate in their discussions. He was still looking down through the literature, trying to find relevant papers that supported or disproved his hypothesis. When he heard this, Yuan Ping'an suddenly raised his head, frowned and asked, "What?"

Dr. Bruhn rolled his eyes and repeated what he had said, adding, "I really don't think a 1.5T MRI can have that effect on the human brain to that extent." The implication is that the only thing that can cause this effect is mannitol.

"But...... Mannitol is a dehydrating agent. Sun Lien frowned and asked, "If the dehydrating agent will cause a change in the occupancy, wouldn't that be an explanation...... These low-intensity shadows are not edema?"

Hypointensity is an area of tumor mass with edema rather than blood vessels. This inference is the central key to supporting Dr. Pascal's diagnosis of anti-AQP-4 antibody-negative NMO. If it is determined that this hypointense shadow is not edema, it is tantamount to a complete rejection of Pascal's diagnostic direction.

"Who knows. Brunn patted his belly, then continued to bow his head and began to nibble on the case, "The change in intracranial mass can't always be caused by blood sampling, right? Isn't that the basic principle of reasoning?"

Zhou Ce didn't hesitate to slap Brune, "The premise is that you can list all the options - we haven't even figured out whether this disease is spontaneous or secondary, congenital or acquired." How can you be sure that we have listed all the possibilities, and what if it is some unknown disease?"

Although it sounds like a bar-raising...... But all the doctors present had to admit that Zhou Ce's raising of the bar was actually quite reasonable.

Yuan Ping'an pressed a few keys on his computer, and then the whole office sounded the sound of a printer "crunching" working. With this voice, Yuan Ping'an stood up and said, "Although I can't be completely sure, I think I have found a possibility that seems to be very credible." ”

He walked to the printer and handed out the paper he had printed to Sun Lien and others. This is a related paper from the Third Affiliated Hospital of Yangcheng Medical College, entitled "Effect of mannitol on the expression level of aquaporin 4 in ischemic cerebral edema".

"Let's skip the experiments and look at the conclusions first. He held the paper and said to the crowd, "Mannitol has an inhibitory effect on AQP-4. ”