It is practically impossible to rely on a medical team of five to six people to treat all possible incurable diseases, as Dr. House did.

With so many specialties and so many different diseases, it is absolutely impossible for five or six doctors to deal with them all.

Sun Lien was in the remote consultation office, looking at the many unfamiliar faces on the screen, and Dr. Pascal, who was speaking so fast that he seemed to be freestyle, and there was only one thought in his heart - this thing...... It's really easy to use.

It has been more than six years since the teleconsultation office was put into operation. The large-budget facility has only been in operation less than 20 times in six years. Nearly half of them are used to test whether the equipment is functioning properly.

Like many doctors who don't have a particularly rich network, Sun Lien has always felt that remote consultation is actually a bit of a "face project". After all, this thing is essentially just a nail in the coffin - through remote PPT and voice and video communication, experts in other regions are involved in the diagnosis.

But this time, Tubao Sun Lien was an eye-opener. In the remote consultation, experts on the other side of the ocean kept coming up with various and even unbelievable treatment plans. With these complex and complex solutions alone, this consultation is worth the ticket price.

In normal times, who would propose to perform genetic sequencing on patients first, and then select IL-2R (interleukin-2 receptor) and early withdrawal of hormone suppression based on the sequencing results?

"This patient is in a very special situation. After rejecting a number of routine immunization regimens in a row for twenty minutes, Dr. Pascal gradually came to his own ideas. "We need to develop a specific immunosuppression regimen for her – for better postoperative recovery and development, I personally prefer to withdraw hormone suppression early. ”

Hormone suppressive immunity is the most common clinical immunosuppressive regimen. But it is also the most widespread. In addition to suppressing the immune system, it also severely affects the normal growth and development of the human body and increases the cardiovascular risk of patients. Nowhere is this more evident than in pre-adolescent children.

"We also lack experience in dealing with people with cirrhosis in this age group. The hepatologists who consulted remotely showed their helplessness and dissatisfaction unabashedly, "The viral load in the patient's body is still a little high. The safest approach is to continue treatment for hepatitis B and wait for a transplant with an isoload below the test level. ”

"We've already done this once. Dr. Pascal spoke, and the pediatric specialist interjected unceremoniously, "Based on the patient's current physical condition and conditions, she would have died long ago by the time her hepatitis B viral load was suppressed." ”

Another specialist who specializes in organ transplantation expressed support for the paediatric specialist's opinion: "Don't confuse this patient's situation with other patients who have received organ transplants. The liver she received was itself considered a waste reuse. So don't worry too much about how long the organ lasts – as long as the newly transplanted liver lasts longer than originally expected, the plan is considered a success. ”

One of the most important principles in transplantation and post-transplant immunotherapy regimens is the need to preserve the transplanted organ as much as possible. Organs donated by others are very valuable resources. Once the transplanted organ cannot be used for various reasons, a second operation is often required to remove the transplanted organ.

The loss of a transplanted organ is acceptable for some patients, but for many more it is like a death sentence. But "acceptable" patients are not without danger – when a person is immunosuppressed and undergoes another operation, the risk of postoperative infection is magnified many times over.

Therefore, in the past suppression regimen, doctors have tried to ensure that the patient's organs can function for as long as possible after the transplant. Therefore, in addition to ensuring that the occurrence of acute rejection is avoided, the immunosuppressive regimen used in organ transplantation will be more "ruthless".

To put it mildly, people with weakened immunity are prone to get sick, but they can still be treated with medication. However, if there is a rejection reaction in the transplanted organ, it is not a problem that can be solved by taking medicine alone.

"At the very least, acute rejection should be avoided. After several experts expressed ridicule and contempt and approval to each other, Dr. Pascal finally made a decision, "IL-2 combined with tacrolimus and prednisone for immune induction, and lamivudine is used to fight the virus." The latter regimen is decided on the basis of the patient's condition, with entecavir for antiviral therapy. If the situation is good, the hormone can be withdrawn early. ”

"Have you learned anything from watching people engage in remote consultation?" Zhou Jun met Sun Lien, who was swaying and dazed, at the door of the office. In the afternoon, Zhou Jun knew that Sun Lien had to go to the remote consultation room to observe this high-level transnational consultation, and the four hospitals themselves also discharged a number of doctors from rheumatology, immunology, infectious diseases, and pediatrics to participate in the consultation. He looked at Sun Lien's appearance and said with some curiosity, "Why do you look like you haven't woken up?"

Sun Lien looked at Zhou Jun in a daze, and it took a second or two to realize that the senior brother was talking to himself, and he said embarrassedly, "I went to listen to the consultation for several hours, and my brain was a little foggy. ”

"So, what have you learned?" Zhou Jun did not mean to criticize Sun Lien. After all, he is a doctor from the emergency department, and it is definitely a super-standard task to engage in an immunization program, in his opinion, as long as Sun Lien learns a little knowledge from it, it is not a loss, "For example, the principle of arrangement of the immunization program or something?"

"I ......," Sun Lien smiled bitterly, "I learned a lot of English foul language." ”

·

·

·

"That kind of thing came to me to learn. Brune laughed back and forth in the small conference room, and criticized Sun Lien mercilessly, "How many useful words can you learn from those New Yorkers? All the swear words they have learned together are not as useful as a Mother Fuker." ”

Sun Lien, who ate two pieces of chocolate in a row and replenished the sugar, glared at him, "Do you think I was scolded by Director Zhou badly enough?"

"Director Zhou is such a gentle person, how ruthless can he be in scolding. Brune waved his hand wildly, "It's not that I'm arrogant, people with hair can't scold people hard enough." ”

"If you think Director Zhou is amiable when he scolds, it means that you haven't learned Chinese at home. Dr. Pascal walked in with a thick stack of papers, and after habitually snorting Brunn, he looked at the crowd in the small conference room, "Dean Song told me that the office of the Comprehensive Diagnostic Center is ready for use. Let's get ready and move things over. ”