I don't know if it's because of the face of sixty cups of coffee, or if Zhou Jun is worried that he will really ask something, so he didn't let Sun Lien stay in the emergency room, ready to face Chen Xiao's parents. He just asked Sun Lien to send a copy of the recording he had recorded, and then sent him back to the diagnostic center to work.

The comprehensive diagnosis center stands in the cold wind, and the exterior walls of wood grain and fair-faced concrete are somewhat inconsistent with the other buildings of the fourth courtyard.

Sun Lien walked into the office and saw Yuan Ping'an, who was sleeping on a folding marching bed—with a thick stack of bound white paper beside him.

Before the time of the morning shift, Sun Lien thought about it and quietly closed the door again. Yuan Ping'an's appearance knew at a glance that he hadn't come home at all last night, and the ghost knew what time he tossed before he went to sleep. At times like these, there is really no point in caring for any kind. It's better to let people sleep a little longer.

Sun Lien walked to the nurse's station, asked the nurse on duty for a piece of waste paper, wrote the words "Yuan Ping'an is resting, please go to the conference room first" with a pen, and then pasted the paper on the door with scotch tape. Then, he walked to the small conference room by himself and began to use his laptop to retrieve yesterday's Tang Min examination results.

While looking at the inspection results, take a screenshot of the appropriate picture and throw it into the PPT to display. Sun Lien's work was very smooth, and after about forty minutes, almost all the doctors in the first treatment group appeared in the small conference room—except for Yuan Ping'an, everyone was basically there.

"This is the result of yesterday's imaging test. Sun Lien connected his laptop to the projector, and then began a special morning meeting report. "Yuan Ping'an didn't know what time it was to work overtime yesterday, and he was still asleep when I went to the office in the morning. So I didn't call him in the morning meeting, after we finished the meeting, I just sent him this PPT again. ”

Of course, everyone has no opinion on this, after all, when it comes to the importance of catching up on sleep after working overtime, everyone in this room understands it very well.

"The patient's name is Tang Min, and he ......is seven years old this year," Sun Lien repeated Tang Min's basic situation again, and emphasized, "Yesterday afternoon, when I was taking a medical history of the patient's family, I got a special situation - her uncle, that is, Tang Min's mother's younger brother, also had similar symptoms once when he was about eight or nine years old. The main manifestation is a rapid loss of vision, which then resolves on its own. ”

The news caught everyone's attention. Xu Yourong's expression was strange, "Shouldn't genetic diseases be directly considered?"

"Tumors cannot be ruled out. Sun Lien shook his head, "It is possible for patients under the age of 18 with type 1 neuroblastoma to heal on their own, and I dare not take this risk when there is no clear lesion in two biopsies." ”

Sun Lien's explanation was unanimously approved by everyone. Even Xu Yourong nodded, and then she asked, "Then do you still need to do this biopsy?"

"The optic nerve biopsy is put back a little bit. Sun Lien thought about it again and again and decided to postpone this inspection a little. "I have asked Yuan Ping'an to take blood and send samples for whole genome sequencing, and the results will be available in about two weeks. After whole-genome sequencing has completely ruled out the risk of genetic diseases, it is not too late to consider a biopsy - if she is really a tumor, she should still be able to afford to wait two weeks. ”

Neither Zhou Ce nor Dr. Brunn had heard of the proposal of optic nerve biopsy. The two looked at each other, then frowned together.

"Optic nerve biopsy is really a safe option. Dr. Bruun said with a frown, "But this is the time to do it...... Wouldn't it be a little too radical?"

"You don't say that like human words. Zhou Ce is now familiar with Dr. Brunn, as if he can wear a pair of pants, "The front says safe, the back says radical, and you say both the pros and cons, what is this called?"

"Compared to a repeat white matter biopsy, an optic nerve biopsy is really more secure. At least the only after-effects are impaired eyesight. Dr. Brunn stretched, "But the biopsy itself is very risky, and wouldn't it be better if there were other means to determine the nature?"

"The only criterion for diagnosing a tumor is a biopsy. Zhou Ce spread his hands, "The detection of genetic diseases is already underway, if there is no possibility of genetic diseases, then consider biopsy - isn't this risk sharing already well planned?"

"I have an idea. Brunn's eyes suddenly widened, and he leaned forward and said to Sun Lien, "This little girl's lateral ventricle has been shunted, right?"

"That's right. Sun Lien nodded inexplicably, "I have had a lateral ventricular shunt in Yuanhai Hospital, and it is also shown in the imaging data." ”

"If it's a tumor, then these unstable cancer cells can easily break off from the tissues and then go through the cerebrospinal fluid circulatory system into other tissues to latent and grow. Brunn continued, "I think there might be something to be done here. ”

After working as a doctor in China for several years, Dr. Brunn's Chinese skills have improved by leaps and bounds, and he can even say such things as "making a fuss". But Sun Lien didn't care much about Dr. Brunn's Chinese level, he was more concerned about the content of "making articles".

"What do you mean......" Sun Lien frowned and continued with Dr. Brunn's train of thought, "We should consider checking her lymphatic system?"

The lymphatic system and the blood system are the main pathways for cancer cells to metastasize, and from the current multiple mass locations in her brain, these cancer cells are most likely to metastasize through cerebrospinal fluid if they are tumors. "There may be traces of cancer cells in her cerebrospinal fluid, and there may also be traces of tumors in her pleura and lungs." I think it's important to do more of her CSF exams more frequently – if necessary, do a minor surgery and set up a fistula that can be sampled through the shunt channel. And I personally recommend doing a PET scan of her to see what is going on in other areas. ”

If such a fistula can be successfully established, it is of great significance for routine examination of Tang Min's cerebrospinal fluid components. Cerebrospinal fluid examination generally requires a puncture of the lumbar spine – referred to as lumbar puncture. This kind of puncture is very painful, and adults can't bear it, let alone a seven-year-old girl? If the cerebrospinal fluid had to be checked every day, it would be almost inevitable to have an early surgery to establish a fistula - a daily lumbar puncture would be no different from torture.

As for PET scans...... Sun Lien asked Xu Yourong with some suspicion, "Our hospital ...... Can you do it with PET?"