The results of bone puncture and lymph node puncture were almost successively sent to Dr. Jiang and Sun Lien. Looking at this inspection report, the two of them breathed a sigh of relief.

Not leukemia.

Bone puncture results indicate that bone marrow hyperplasia is markedly active, which is a bad sign. But the lymph node biopsy pulled the eyes of the two internists directly away from leukemia.

Lymph node biopsy suggests acute purulent lymphadenitis.

Sun Lien got the inspection report in the sailors' dormitory. When he got the report, he was chatting with the sailors who were cleaning in the dormitory. When he heard the sound of footsteps, the sailor with the mop suddenly jumped up from the side of the bed, and dragged the mop back and forth on the ground with the mop.

After seeing that it was Dr. Jiang, the sailor threw down the mop and breathed a sigh of relief, "I'm scared to death, I thought it was the company commander coming." ”

Dr. Jiang usually likes to chat with these little soldiers, but today he is not in this mood. He stuffed the inspection report into Sun Lien's hand, and then said urgently, "It's not leukemia, it's an infection!"

Sun Lien looked down and read the report, his eyebrows wrinkled together. Leukemia does not cause acute purulent lymphadenitis. This is necessarily an infection.

He blinked, and suddenly remembered the female patient he and Hu Haibo had taken over to treat - the patient with bacterial meningitis named Lennie.

After switching to meropenem, the female patient improved at a rate that was visible to the naked eye. However, due to the change in the situation, the female patient was taken out of the hospital by her family after three days of treatment. Hu Haibo and Sun Lien didn't figure out what kind of bacteria she was infected with in the end.

However, Lena and Kaoru Kobayashi's conditions are somewhat similar - they have both been treated with other antibiotics, and these antibiotics do not help their condition in any way.

"It is important to identify the pathogen of infection as soon as possible. Sun Lien communicated with Dr. Jiang and decided to speed up some of the testing progress. "It's not enough to have a blood culture, you have to do a sputum culture as well. ”

"Do you still think he has a respiratory infection?" Dr. Jiang was a little relieved, since he saw the CT scan, he gave up the idea of doing phlegm culture on Kaoru Kobayashi. CT does not show the foci of infection, which means that the infected bacteria may not be collected at the time of sample collection. He had other ideas for such an examination. "I think...... Why don't you do a full-body scan?"

"He's infected, so it's a PET ......" Sun Lien was about to refuse this request, but he suddenly thought about it, and then slapped himself on the thigh, "Yes!

One of the characteristics of military hospitals is that when treating sick or wounded soldiers, they often spare no effort and do not care about the cost of work. As long as the warrior needs it, even the most expensive treatment can be done.

But Sun Lien's Fourth Central Hospital is different. When they prescribe tests in hospitals, they not only need to consider whether the patient needs them, but also weigh the price of the test and whether the patient and their family can afford it. Some of the tests that are too expensive and time-consuming, even if they can immediately detect the patient's condition, the doctors in the local tertiary hospitals may not be able to prescribe them - if they can't afford it, they refuse to treat it, which will have the opposite effect.

That's why Sun Lien rejected the PET scan, but he quickly reacted. There is no charge for PET scanning on the Daishan Island. Even if he wants to collect it, with Takeda Pharmaceutical's net worth, Kaoru Kobayashi will never be able to afford the cost of the examination. Now, a PET scan can not only determine the location of the infection lesion, but also determine whether Kaoru Kobayashi has a solid tumor on his body. Such a good thing in one fell swoop, of course Sun Lien will not object.

"Then I'll arrange it. Doctor Jiang nodded, and was about to turn around and leave, but was called back by Sun Lien, "Let's ...... Can I do mNGS?"

Sun Lien didn't intend to cut corners, he asked this question out of prudence. Although so far, there is no tangible evidence that Kaoru Kobayashi has an autoimmune disease, the three positive antibodies on the status bar really made him feel a little uneasy. If Kobayashi has an autoimmune disease, the probability of being infected with pathogenic bacteria will increase dramatically. Many of these opportunistic pathogens are resistant to one or more antibiotics.

If it's really opportunistic pathogens...... Sun Lien was really worried about whether he could meet the antibiotics that happened to be effective like a dead mouse before the bacteria killed Kaoru Kobayashi. If you want to be safe, the best thing to do is to use mNGS directly to determine the type of pathogen.

"This ...... The ship really can't do it. Unexpectedly, Dr. Jiang showed a somewhat embarrassed expression, "mNGS is usually used too rarely, and when this ship was designed, it was ...... There is no such technology yet. ”

Daishan Island began preliminary design work in 05, officially started construction in 06, launched in 07 and delivered to the troops in 08. The first application of mNGS technology to detect the source of infection began when a 14-year-old child returned home from a trip to Puerto Rico in 13 years with severe hydrocephalus and epilepsy. The clinician was puzzled and finally decided to seek more advanced technical help. It was also at that time that mNGS technology was first applied to find the source of human infection.

Eventually, the 14-year-old was diagnosed with leptospirosis. And this whole process was also published in the New England Journal of Medicine that year. And in 16 years, this technology was officially introduced into the country and began to be widely used.

And the Daishan Island, which began design work in 05, is unlikely to leave enough space for technical equipment that entered the country after 11 years.

"If you have to do it, you have to take the samples from the ship, fly them to Tanzania, and then send them to South Africa by civil aviation or fixed-wing aircraft. "As a military doctor, Dr. Jiang is very familiar with the area where he is on a mission. "There is no technology and equipment for mNGS detection in Polytavia, nor does Tanzania and Mozambique. The closest one is probably South Africa – or else it would have to be delivered to Dubai. ”

Now it is Sun Lien's turn to puff his teeth, and he only knows that the Daishan Island is designed and built according to the level ......of a "tertiary hospital". However, he did not expect that the equipment here would be affected by the special environment of the ship's design age and hull - the absence of MRI on the ship was enough to shock Sun Lien.

"Let's do a PET scan first. Sun Lien sighed, the conditions are limited, so he can only pick the tests that can be done first, and then say, "I'll go talk to the family, at least find out what antibiotics were used for him before." ”