"Help him out, won't you?"

Zhang Lin worries that the intern will fall again.

In case there are three longs and two shorts, no one can afford this responsibility, and more is better than less.

The intern shook his head stubbornly and insisted on staying in the operating room, as a surgeon, he would have to face more exciting scenes in the future, and this level must be passed.

Song Zimo seemed to see himself back then, leaning on the wall of the Demon Six Emergency Center, swaying, and spinning.

He understands the psychology of the intern best at this time, for fear that he will be kicked out of the surgical profession because of this matter, even if his heart is turned upside down, he must pretend that nothing happened, in order to tell everyone: I can!

"Let him stay, be careful, feel free to say anything uncomfortable, it's actually nothing, I've seen too much natural habits." Song Zimo encouraged the intern and asked Zhang Lin not to ask him out.

Song Zimo's words, Zhang Lin naturally did not dare to disobey, Song Zimo's status as the second brother of Corey was unshakeable.

In the past, Zhang Lin and Xiao Wu often dreamed of competing for the position of the third brother, but since Xu Zhiliang joined, they completely cut off this idea.

This stammer, not only is he a little paranoid in his efforts, but the key is that his brain is good, and even Zhang Lin suspects that this person's mouth can't keep up with the speed of his brain, so he stammers.

The excision of a gouty nodule is no different from the excision of a mass on the surface of the body, and the first level of surgery is the most basic surgery.

However, it is very difficult to maintain the normal healing of the postoperative surgical incision, and every detail must be pursued to the extreme, the hemostasis must be thorough, and the layered sutures must be tight, so that there can be no leakage.

Once leaked, the interstitial fluid mixed with uric acid crystals seeped out of the gap in the surgical incision, resulting in the incision eventually not healing.

"Lime" is impossible to clean, it is almost everywhere, it has penetrated into cartilage, synovium, joint capsule, ligaments, tendons, almost every tissue around the joint is eroded by it, this erosion has no boundaries.

As long as the clump "lime" is removed, a large amount of normal saline is repeatedly rinsed, and the white turbid "lime" water flows from the suction device to the suction tube into the collection bottle.

Excess skin and fascia were trimmed, incisions became fusiform, and negative pressure drainage was placed at the surgical site for some large gout nodules.

After hard work, more than 40 gout nodules in the body were gradually removed, and the operation was completed.

The patient returned to normal in appearance and was no longer an annoying "monster", and both lower limbs were amputated from the knees, the result of years of indulgence in gout.

In the future, if he can insist on taking medicine and control uric acid in the range of 180-300μmolL, he still hopes to live a normal life, and some of the uric acid crystals deposited in the body will slowly dissolve.

The intern resisted the discomfort and finally stabilized himself, although his face was ugly, he did not fall down after all, and pretended to stand in the operating room relaxedly, announcing that he could be a surgeon.

"Fatty, you haven't had a gout attack for a long time, right?"

Zhang Lin took the opportunity to ask when Liang Fat Man had some free time.

"I haven't had a seizure for a year, and allopurinol is one tablet a day, which is as punctual as washing my face and brushing my teeth, and now my uric acid is stable in my early 200s."

"My father-in-law also has gout, do you have any good advice on medicine?" Zhang Lin returned to the truth, and Xiao Wu also listened attentively.

The lecture is short, and many things are still not fully understood.

"Do HLA-B*5801 gene screening, if negative, the first recommendation is allopurinol, don't look at it cheap, think it's cheap and not good, if the HLA-B*5801 gene is negative, there are no other contraindications, allopurinol is definitely the best, whether it is the effect or safety, it is the best, the latest guidelines of the American College of Rheumatology on gout, the recommended first-line drug is allopurinol, in view of the high proportion of HLA-B*5801 gene positive in Han people, I do not make first-line recommendations, However, if HLA-B*5801 gene negative is confirmed, allopurinol is preferred. "Liang Fatzi is unequivocal, he has studied these drugs badly.

"It makes sense, the elderly have some high blood pressure or something, febuxostat is still cautious, I asked him to do HLA-B*5801 genetic monitoring when I have time, it seems to be a few hundred dollars, right? If it's negative, I ask him to switch to allopurinol. Zhang Lin got a clear opinion, so he was relieved.

Xiao Wu also wrote it down, hoping that his father-in-law's HLA-B*5801 genetic test was negative.

"Over the bed!" Xu Zhiliang took off his gloves and threw them into the yellow collection bucket, and gave an order.

As Zhang Lin's senior doctor, Xu Zhiliang is full of majesty.

Hearing the call of the senior doctor, Zhang Lin immediately cheered up, and together with the trainees and interns, lifted the patient and transferred the patient from the operating table to the flat car.

The two amputated limbs were packed in plastic bags with labels, and the cleaners in the operating room came in to complete the handover operation and send the short limbs to the pathology department.

"It's best to go to the pathology department for three months, stand next to the collection table in the giant examination room, eat meat buns, and watch the teacher break down the liver, stomach, intestines, etc., and you will pass the test." Song Zimo patted the intern on the shoulder.

The intern felt sick in his heart, and when he heard this scene, he was sick to his stomach, not to mention eating steamed buns while watching, what a high level of cultivation.

At this time, Yang Ping answered the phone in the corner, and Huang Jiacai from the magic capital called.

"The external spinal fixator has been delivered to the Guilin laboratory, we have to take time to go to Guilin, the operation of forty monkeys is estimated to take two days, fatty, you go with you, the monkey's anesthesia is no problem, right? Little Five, you make arrangements for travel. Hanging up the phone, Yang Ping arranged a mission to Guilin.

"Coming over this Friday? Song Gongzi and I will go with you, Lao Xu and Zhang Lin will guard the ward, next time we will be transferred, we will leave after work on Friday and return on Sunday night, and I will ask them to prepare the skin a day in advance. Xiao Wu is responsible for outreach, and the outreach activities of these scientific research activities also fall within his scope of work.

Skin preparation is the removal of hair from the surgical site and the cleaning of the skin.

The body hair of monkeys is much more lush than that of humans, and it is also a heavy task to prepare skins, and forty monkeys have to remove all the body hair on their backs with an electric razor.

"There are narcotic equipment and medicines, and I have shown you the list of equipment and drugs, is there any problem?" Xiao Wu asked Liang Fatzi.

Anesthetize the monkeys, forty at a time, and this is the first time.

The dosage of anesthetic can only refer to the human body, according to the weight of the monkey to adjust, Liang Fatzi also consulted the tutor in Huaxi in advance, the tutor is studying a new type of local anesthetic, is currently in the animal experiment stage, the anesthesia after the experiment, the tutor has rich experience.

Scientific research is hard work, especially some basic scientific research, which is very hard, hard and tiring, and there is no money, so naturally no one wants to do it.

However, basic scientific research is the most important, just like the foundation of a building, without a solid foundation, no matter how beautiful the building is, it will be in vain.

Forty monkeys, after the operation, implanted with the external fixator, after the operation, the external fixator is adjusted every day, which screws, how many times a day, how many scales are rotated at a time, must be meticulous.

This is not enough, the monkey should be regularly taken X-rays, MRI, CT, analyze these imaging data, take some tissues under the microscope, carry out histoembryological analysis, dynamic observation of the firmness of the needle fixation in the external fixator, and if there is a problem in the middle, record and analyze the problem.

These tasks will be completed by the doctors sent by Xiehe, who have good scientific research literacy.

The patient woke up from anesthesia and returned to the ward, although there was gauze all over his body, there were no bulging bumps under the gauze.

If all goes well, after fourteen days, he can wear a prosthetic leg to train his walking ability.

Back to the ward, Yang Ping had nothing to do, and called up the monkey image pictures sent by Guilin to read, Xiehe's laboratory in Guilin is well-equipped, the quality of these images is very high, the whole spine is X-ray, CT three-dimensional reconstruction, MRI various sections, shooting is very standard.

In order to get the best possible images, the laboratory staff thought of many methods, they designed X-ray transparent mounts, fixed the monkeys on the rack, and then examined them.

These little guys don't let you check it out in a regular way, and even if it's fixed to a shelf, some pictures need to be photographed many times to get it.

"You said that this monkey's X-ray really looks like a child's?"

"Darwin didn't say that man evolved from apes."

"Look, how many physiological curvatures are not very obvious?"

"yes, why is the physiological curvature not obvious."

Zhang Lin and Xiao Wu also gathered around to watch.

"The video data here, not only the 40 monkeys we experimented, but also many of their experimental monkey data, the physiological curvature of the spine is formed after people walk upright, although the monkeys can stand upright for a short time, but most of the time they crawl on all fours, so there is no typical human physiological curvature of the spine." Yang Ping explained to them.

Professor Qin Sihe, an orthopedic expert, once had a paper analyzing the formation and correction of deformities from the perspective of evolutionary theory.

"Do you think monkeys will have a herniated disc in their lumbar spine?" Zhang Lin asked Xiao Wu.

Xu Zhiliang was very surprised by Zhang Lin's question: "You are crooked--- right--- why did --- --- put forward the --- today--- it is so profound." ”

Instead of speaking in front of the wall every day, why are you stuttering again?

Zhang Lin dared to be angry but didn't dare to speak.

"You see, these are MRI spine MRIs of elderly monkeys, and look, the bottom three intervertebral discs of humans are the fastest degenerating, and in old age, they must be dehydrated and show low signals, but monkeys don't seem to have this problem." Yang Ping called up some information to show him.

"So--- if you hadn't ---- this problem--- I'd have called you Teacher Zhang." Xu Zhiliang really feels that this question has depth.

"Why don't we finish our retractor monograph and study the differences between monkey and human lumbar disc degeneration?" Little Five proposed.

"In fact, if we look at it from the perspective of evolution, the human intervertebral disc is defective, and it has not yet had time to evolve well to adapt to human upright walking, so it is prone to problems." Song Zimo is also thinking about this problem.

Yang Ping partially agrees with this point of view: "Degeneration is irresistible, and the degeneration of the human locomotor system always starts from the parts where the stress is concentrated, such as the lower lumbar vertebrae and knee joints, which are all stress concentrated parts, and the anatomy and function are adaptable, but the anatomical aspects of these places have not been strengthened." ”

To solve clinical problems in medicine, it is necessary to start thinking from the basics.