Although Sun Lien is only an emergency medical practitioner, after more than half a year of special practice by Dean Wu, his mastery of various diseases has far exceeded the level of the same annual prescribed medical practitioner. If it is not compared with the top hospitals in China, Sun Lien's business level can basically be on par with the attending doctors with low years. If you only look at the diagnostic ability, especially when it comes to the diagnosis of critical and severe diseases and non-genetic rare diseases, then Sun Lien can even be compared with some deputy chief physicians with low years.

At least as the deputy chief physician, Xu Yourong is far inferior to Sun Lien's ability in diagnosis.

Dr. Pascal fell silent after listening to Sun Lien's opinion, he had no doubt about Sun Lien's personal ability. But this set of diagnostics is really ...... Appalling.

Myelin oligodendrocyte glycoprotein (MOG) antibody disease is an idiopathic inflammatory demyelinating idsease (IIDDs) mediated by MOG antibodies.

The number of MOG antibody diseases is not too large, but it is definitely not enough to meet the criteria for rare diseases. Although the pathogenesis of this disease is unknown, its basic principles as a type of immune system disease are not much different from other immune system disorders that cause damage to the nervous system—a mistake in which the immune system mistakenly marks a portion of nerve cells as antigens and organizes immune cells to attack them. The result of the attack is an inflammatory response in the nervous system, which eventually manifests as damage.

As a disease with a lack of specific symptoms (other than conus myeloids involvement), MOG antibody disease is rarely targeted as a first-tier target for diagnosis. Unless doctors have exhausted all other conditions that can cause symptoms, they can rule out. The first step is to determine whether the patient has a demyelinating lesion, and then to consider whether the lesion is inherited or acquired—and then whether it is a primary or secondary demyelinating lesion. All in all, considering MOG antibody disease means that at least three rounds of screening are required to determine that the patient has a primary acquired demyelinating lesion.

The core gold standard for the diagnosis of MOG antibody disease is the detection of MOG antibody itself—MOG-IgG seropositivity detected by a cell-based assay with full-length human MOG as the target antigen is the decisive evidence for the diagnosis of MOG antibody disease.

Sun Lien obviously did not have this evidence at hand - it was only two hours after the patient was transferred to the fourth hospital, and even if the person started to collect blood for testing as soon as he arrived at the hospital, two hours was not enough for the laboratory department to conduct a MOG-IgG serological test.

This made Dr. Pascal a little difficult, and modern medicine requires evidence-based treatment. But Sun Lien's diagnosis was so good that Dr. Pascal couldn't figure out his diagnostic ideas, let alone directly judge whether Sun Lien's diagnosis was conclusive—he couldn't even figure out what was wrong with Sun Lien's diagnostic logic.

"Look, I know you're a genius at diagnosing. Dr. Pascal was silent for a long time before rubbing his head and saying to Sun Lien, "But you also have to be considerate of the difficulties of an ordinary doctor like me—from your description alone, I really can't see the basis for this diagnosis." Let's put it this way, why don't you explain to me why you can link the optic neuritis of three years ago to the epilepsy of the present. ”

Sun Lien was stopped by this question. After combining the neurological diseases of three years ago with the current neurological diseases, it can be determined that Shen Qiushi's disease is MOG antibody disease. It's a smooth logic, but the reason to put the two together is ...... It's not strong enough.

Sun Lien thought about it for a while and decided to say it bluntly, "The reason why I linked the previous illness to epilepsy is because the doctors in the second hospital did not have this medical history record. The patient was hospitalized in the second hospital for more than a week, and they made several medication adjustments for the patient's epilepsy, but the onset still did not improve. Moreover, the numbness and progression of the patient's limbs are consistent with the symptoms of demyelinating lesions, which must be taken into account if demyelinating lesions are to be linked to epilepsy. After all, the rate at which his disease progressed did not match the characteristics of secondary demyelinating disease. ”

"In other words, you put optic neuritis and his current situation together, and it is only because of this that it is more logical?" Dr. Pascal looked at Sun Lien calmly, shook his head, and said, "Your judgment may be right, to be honest, I also think this is more likely." But I can't approve your treatment until stronger evidence is available. ”

"Once you have a clear direction of suspicion, what you should do is not to come to me right away and tell me about your treatment options. Instead, we will take the test right away and discuss the treatment after we have solid and strong evidence. Dr. Pascal sighed, "Even if the antibody test takes more than eight hours, it's always okay for you to make a visual evoked potential diagnosis in advance, right?"

Sun Lien nodded, this is indeed something he didn't understand, of course, he hasn't said anything more important yet, "I think that since this patient is likely to be an autoimmune disease, it's best to leave it to you to deal with......"

"Okay. Dr. Pascal nodded, then said seriously, "I'll take over when you've been diagnosed with his MOG antibody disease." ”

Sun Lien blinked, "Lao Pa, have you learned from Senior Brother Zhou?"

"This is what Qian Hongjun taught me. Pascal laughed, he imitated Qian Hongjun and scolded with a smile, "Hurry up and work, or I will deduct your performance!"

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Lao Palai came to the Fourth Hospital for more than half a year, and was finally successfully taken to the ditch by the directors of the Fourth Hospital. In the past, when there were cases that needed to be handed over to him, this small old man was very willing to take over the patients and carry out related treatments. But now...... Sun Lien wiped a handful of non-existent tears on his face with some grief and indignation, and complained to Xu Yourong, "He actually learned to shirk!"

"Isn't that good? Xu Yourong's expression on his face was as usual, and the visual evoked potential test was one of the more commonly used diagnostic contents of Shenwai. This experiment records potential changes in the visual cortex or occipital area outside the skull by a specific visual stimulus. It is an important tool for the study of human sensory function, nervous system diseases, behavior and mental activity. Sun Lien had never been exposed to this kind of equipment before, so Xu Yourong would accompany him to see the test results. As for the one who really got started with the examination, it was Sun Lien's college roommate Feng Ming.

"The director of the department does not pounce on the front-line clinic, which has advantages and disadvantages. Feng Ming also participated in the conversation between the two. Since he and Qin Ya received the certificate, this kid has gained weight like blowing up a balloon. And his face is filled with that happy smile that makes people want to beat him up when they look at it. Especially after Xu Yourong gave Qin Ya a cerebral artery bypass, this physiologically disgusting smile appeared more frequently. Of course, this may also be just the illusion of Sun Lien, who was forced to be "pseudo-single". "On the bright side, at least the director won't come to snatch your papers—Director Pa doesn't seem to have any pressure on the article, right?"

"Why not?" Sun Lien and Feng Ming said without a match, "People are now in charge of such a large laboratory, and the academic pressure is definitely greater than that of other department directors." ”

"I think it's probably Dr. Pascal himself who can't keep up with your thinking. Xu Yourong interjected on the side, "There are too many faults and jumps in your diagnosis. It's a bit of a stretch – and even a bit of a loss of face – to figure out why every jump and fault is taking place. She glanced at Sun Lien, "I still don't understand how you can connect his optic neuritis with MOG." ”

Feng Ming asked with a smile, "Then Doctor Xu, aren't you afraid of losing face if you ask this?"

"I paid for the tuition. Xu Yourong said seriously, "If you don't ask for fear of losing face, won't the tuition fee paid be wasted?"

"That's right......" Feng Ming suddenly interrupted the small talk without warning, "Huh?"

"The result?" As soon as Sun Lien heard this movement, he suddenly came to his senses, "What's the situation?"

Feng Ming pointed to the screen and said, "The incubation period of P100 in the right eye is a bit long, and this waveform is not quite right...... he squinted his eyes and looked at the results carefully, "The incubation period of the right eye is 128ms, and the left eye is a normal 100ms, and you can see that the voltage of this potential is also very low...... That's only 2.5 microvolts. ”

"I don't understand, just say the conclusion. Sun Lien said expressionlessly, "Can you prove that there is a problem?"

"There's definitely a problem. Xu Yourong nodded, "Combined with the MRI results, there is a high possibility of MOG antibody disease." ”

Sun Lien stood up and stretched, "That's good." He shook his neck, "I'll go and ask Xiao Guo to prepare to draw blood, and I'll take blood for a serum test when I get back." After the diagnosis is confirmed, the patient is handed over to Lao Pa - I don't believe that he can be lazy anymore. ”

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"Now that the test is clear, let's follow the treatment process you said. Dr. Pascal raised his head in his busy schedule and glanced at the visual evoked potential test report that Sun Lien had brought him, "Well, it's better to add a serological test." ”

"Serological tests are already being done. Sun Lien's eyes widened, "This is different from what he said, didn't he say that you would take over after the diagnosis?"

"There are only a few treatment options for MOG antibody disease, and you've said it before. Dr. Pascal lowered his head and continued to flip through the pile of materials in front of him, and after a while, he said, "Aha!", pulled out a few sheets of copy paper, pulled down his glasses, and looked at the contents printed on them, and nodded in satisfaction. "Pulse therapy with methylprednisolone is given first, supplemented with gamma globulin injections – if the response is not good, then plasmapheresis and immunosorbent therapy are considered. Aren't you all clear?"

"But......" Sun Lien was about to say something, but Dr. Pascal stood up directly, "I'll go see Todd, I'll have a meeting in the evening." He showed a meaningful smile to Sun Lien, "As long as there is sufficient diagnostic evidence, let it go." You're always going to have to get used to getting out of the way of a senior doctor - I think you're used to it pretty well. ”