This doctor has a system

Chapter 297 286. It’s not delicious, I’m going to give a bad review

"Then we have to consider narcolepsy." Gao Feng said, "Can our hospital measure the CSF hypocretin-1 concentration?"

"I'll go ask." Wang Wenhao hurriedly called the laboratory department.

Gao Feng was a little dissatisfied. He had mentioned the possibility of narcolepsy two days ago. A good junior doctor should have taken precautions.

The result of CSF hypocretin-1 concentration measured by immune reaction is an important test for the diagnosis of narcolepsy. However, because it is rarely used in daily life, many hospital laboratories have not carried out some large-scale tripartite experiments. This testing item is only available in the laboratory.

Type I narcolepsy requires the following two conditions: 1. Uncontrollable drowsiness or unexpected lapses into sleep every day for at least 3 months.

2.经免疫反应测定的CSF下丘脑分泌素-1浓度≤110pg/ml，或小于以同一标准测定法获得的正常平均值的1/3。

The presence of cataplexy can further support the diagnosis of narcolepsy.

"It can't be done, and the test specimens need to be sent out." Wang Wenhaohui reported, "The testing companies from the three parties said it would take four working days to get the results."

"That's pretty quick. Let's collect the specimen today." Gao Feng said, "Let's communicate with the family again."

The communication was exceptionally smooth, and no family member wanted Xiang Wencheng to remain like this.

"Don't be nervous when you need to do a lumbar puncture later. It's a very simple operation." Wang Wenhao explained, "You can say anything, but you can't move."

"Is it okay to shake?" Xiang Wencheng asked, "I'm scared."

"Shivering like shivering should be fine, but you should try to control it." Wang Wenhao said.

The full name of lumbar puncture is lumbar puncture, which is a commonly used clinical diagnosis and treatment operation.

It can be used to diagnose various inflammatory diseases of the central nervous system, vascular diseases, spinal cord lesions, suspected intracranial space-occupying lesions, undiagnosed neurological diseases, pneumocephalus, spinal canal angiography, etc.;
It is also used to drain (decompress) the cerebrospinal fluid due to excessive pressure and inject drugs to treat central nervous system diseases.

During the operation, the patient needs to lie on the bed bent on his side with his hands on his knees to widen the lumbar kyphosis and intervertebral space.

Routine local disinfection, infiltration anesthesia, and puncture.Generally, there is resistance when the needle is inserted 4 to 5cm, and the resistance suddenly decreases. Afterwards, the needle core is pulled out, and the cerebrospinal fluid can be seen dripping out by turning the needle tail.

Cerebrospinal fluid is collected according to different purposes and specific conditions.Then insert the needle core, pull out the puncture needle, fix it with a sterile gauze piece, and lie down flat for 4 to 6 hours.

This kind of operation is very simple for people who often do it. Although Wang Wenhao doesn't do it much, there is no problem in getting started.

In fact, Gao Feng wanted to give it a try. Like most graduate students, he had not had a single lumbar puncture during his three years of graduate school.
After all, the needle is inserted into the patient's lumbar space. Sometimes the operator is more nervous than the patient. When I was in school, the teacher showed a video to everyone.

An old man was lying on his side on the hospital bed, holding his knees with his hands, and then his whole body was shaking violently. This is not the point, because the hands holding the puncture needle to operate him were shaking even more violently.

In the end, the two people may have reached an agreement on the frequency of shaking, and the operation was magically done quickly and well.
As the head of the general medicine department now, it seemed a little inappropriate for him to start at this time, so he could only give up with regret.

Wang Wenhao's basic skills are not bad, but Gao Feng only found a few habitual minor problems. This is the result of nitpicking. In fact, the average person should be at this level.

"Okay, let's take this cerebrospinal fluid for testing and let you know the results as soon as they come out." Wang Wenhao pulled out the puncture and breathed a sigh of relief, but Xiang Wencheng didn't give him any response.

Could it be that he fell asleep?He looked at it, and it was true. Now everyone couldn't help but envy the patient's speed of falling asleep. It would be great if it looked like this when he was not sick.

Difficulty falling asleep is a big problem that troubles many people in today's society, mostly young people. Sometimes they are obviously very sleepy, but they just can't fall asleep.

Abbreviation: Too sleepy to sleep.

It may be related to the overuse of electronic products. You can exercise more at night and try not to play overly stimulating games, otherwise you will be more unable to sleep when you are excited.

The games mentioned here are more competitive electronic games, such as CS or DOTA2, not that kind of game.
Although the latter game is exciting, you can actually play it more. The more fun you play, the faster you may fall asleep.

But you must pay attention to your waist and heart rate. Some students were more manic when they were young. When they get older, they still stick to their old ways. They are prone to cardiogenic problems, so be cautious.

It must be done step by step and...
The results of the cerebrospinal fluid came out quickly. The CSF hypocretin-1 concentration measured by immune reaction was ≤110pg/ml.

"You have narcolepsy." Wang Wenhao said to Xiang Wencheng and his family.

"Sleeping sickness?" Xiang's father looked puzzled, "Is sleeping a disease?"

Sleeping is certainly not a disease, but if you have uncontrollable sleepiness regardless of time and place, it is definitely a disease.

"How to treat this?" Xiang Wencheng's wife is more concerned about this. Her husband sleeps all day long, which puts her under great physical and mental stress.

The treatment of narcolepsy focuses on medications, cognitive behavioral and psychological therapies.All treatment goals should focus on improving daytime sleepiness, cataplexy episodes, hypnagogic/post-sleep hallucinations, sleep paralysis, nocturnal sleep, and psychosocial difficulties.

For this patient, it is obvious that psychological reasons are not the main cause, and drug treatment is certainly unavoidable.

"You can use some drugs that stimulate the central nervous system." Gao Feng said, and he specifically checked the relevant literature.Modafinil, armodafinil, and sodium oxybate are standard treatments, and amphetamine, methamphetamine, dextroamphetamine, and methylphenidate are guideline-recommended medications.

"I recommend modafinil."

Modafinil is a wakefulness-promoting drug whose mechanism is unknown, but it is hypothesized that it selectively activates wakefulness-producing parts of the hypothalamus.

The drug can significantly improve daytime sleepiness in patients with narcolepsy.The most common side effect was headache, followed by nervousness, nausea and dry mouth.These symptoms can be reduced by slowly and gradually increasing the dose.Blood pressure should be monitored while taking it as this drug may cause an increase in blood pressure.

"Compared with other drugs, this drug is not the most effective, but the advantage is that Modafinil is not addictive and the possibility of abuse is very small."

"Let me try it first." Xiang Wencheng was still a little worried about his situation. He was afraid that it would be the same after he went back, which would be troublesome.

Generally speaking, the subsequent treatment has obvious results. Wencheng explained to Wen Cheng that he should strengthen exercise before going to bed at night, which will help maintain a regular sleep-wake rhythm.

After taking modafinil orally, the daytime drowsiness was well controlled, and he was able to resist the drowsiness without any recurrence of cataplexy.

"Director Gao, when can I stop taking medicine in this situation?"

"It's hard to say." Gao Feng was a little hesitant. "You follow up regularly, and we'll take a look before we talk."

The truth is that narcolepsy is a lifelong sleep disorder. Drugs and behavioral psychological interventions may help relieve symptoms, but there is currently no cure.But if I tell the patient this matter very directly now, I am afraid it is not very appropriate. After all, he has just established the confidence to live a normal life, and his depressed mood is not conducive to the control of the disease.

In the "International Classification of Diseases, 1th Edition" compiled by the World Health Organization, there are more than [-] disease names recorded, but only a few of them can be completely cured. Most of them are infectious or surgical diseases. The vast majority of diseases are Incurable.

Although the chronic course of the disease will bring long-term pain to the patient, it is still necessary to be optimistic about the future life. After all, there is no other particularly good way except this.

Z University, Pharmacy Laboratory

"Wang Liang, what are you doing?" Yue Penghui asked. Everyone was eating. The former took pictures of his rice bowl with his mobile phone.

"Is it necessary to post this thing you eat on WeChat Moments?" A colleague in the same group said in disgust.

"It's not delicious. I'm going to give a bad review." Wang Liang explained, "Although the food was delivered very quickly, it was already cold when it was brought over. The boss must have forgotten to heat it up, or it was not possible at all. It’s leftovers!”

"So excessive?!" Yue Penghui said he was shocked, "There are too many such unscrupulous businessmen now, and the country should introduce policies to deal with them!"

"What kind of rice did you buy? Was it cold when it was delivered?" After he finished speaking, he came up to take a look, "Oh, the delicious cold noodles?"

"Cold noodles?"

"Are you really sick?" Someone complained, "If I were the boss, I would come over and stab you twice."

"Dirty little thing!"

"But the last time I ate it was obviously warm." Wang Liang argued, "Is it because it was summer last time?"

After hesitating for a while, he did not dare to leave a negative review. Instead, he sent a message to the boss on the ordering software: Boss, can the noodles be made hot?

As long as you are willing to pay for it, what can't I make?The boss thought to himself.

"Then you can bring me something hot later. I have a weak stomach and it's not suitable for me to eat cold food." Wang Liang typed.

If you can't eat cold food, why don't you order cold noodles?He also eats hot cold noodles, this person must be a fool, right?The boss suddenly felt a little sympathetic. He took out the beef he bought three years ago and cut two more slices for Wang Liang.

It makes the boss lady feel bad to see it.

As long as everyone gives a little love, the world can become a beautiful world.

"How is the bioavailability determination going in your group?" Yue Penghui asked.

"The speed is average." Wang Liang replied, "This is not my business." He is responsible for tissue distribution research, including mouse tissue distribution, blood-brain barrier, lymphatic transport and liver extraction experiments.

Among them, the liver extraction experiment progressed relatively slowly. Anyone can kill the mice, but after death, the liver needs to be dissected out in time to extract the substances. This will test the experimenter's skills.Wang Liang did very well, but the others got started quickly, so the overall speed was just like that.

"It's definitely not going to hold you back. Why don't you pay more attention to the absorption distribution of the 4 groups." Wang Liang said, "I see that their group has a sad face every day. It must be that they have encountered a big problem."

Group 4 did encounter a big problem. They were responsible for the absorption, distribution, metabolism and excretion of the drug. Metabolism and excretion are not very difficult. As long as you are willing to liver, the results will come out very quickly.

But the absorption distribution is a test of people's hands-on ability. Measuring the absorption distribution of various parts of the mouse body cannot be said to be extremely difficult, it is also quite not easy.

The leader of Group 4 felt that with the current manpower and machines, it was impossible to achieve the expected goals.

"Then you should tell me!" Yue Penghui was very unhappy, "Don't report anything. If the result doesn't come out, you can explain it yourself."

"I said it, but Hu Gong said that there are no extra people now, so let other groups finish the work at hand first, and I will figure out a way first." The leader of Group 4 defended, "You went back to your hometown at that time, so you I didn’t report it to you.”

So that's it, "Then have you thought of any good ideas?" Yue Penghui asked. He was also overwhelmed. Now every group is short of people and can't find people anywhere.

"I have hired a group of internship students. They should be available in the next two days. Then they can help with some basic work."

This is also a way. At present, the reputation of Fengxin Technology has slowly spread, and some senior students who are not preparing for the postgraduate entrance examination have long been eyeing this place.

Many people want to come in and see what it's like inside, and whether the money given out is as much as the rumors say.

"I'll go to Mr. Hu to report again and apply for some extra expenses for you." Yue Penghui said, "You guys work harder and don't fall too far behind other groups, otherwise it will look bad when the time comes."

Hu Gong was having dinner with someone at the moment, the female doctor from the Department of Nuclear Medicine.

"It's hard for you to make an appointment." The girl was a little dissatisfied. "Aren't you a small boss in the company? You can't arrange your time freely?"

"Except for the big boss, I'm afraid no one else can arrange their time freely." Hu Jiaran replied, "Let's order quickly, I'm already hungry."

The girl curled her lips. This man said he wanted to treat her to a meal today. He thought something was wrong. He only wanted to eat for a long time. It was all in vain that he dressed up so beautifully.

"Then let's get this couple's package."

The waiter quickly brought out a few small plates of side dishes, and then there was no movement.

Hu Jiaran was impatient and asked what was going on. The other party told him that the dishes had been served.

"It's so dark!"

“That’s all for 248 yuan?”

Hu Jiaran couldn't believe it. Who could eat enough?He alone is not enough to fill the gap between his teeth.

"What you come here to eat is the mood and atmosphere!" The girl was speechless to him, "You have to be a little romantic, otherwise you will not be able to get along with your loved one in the future."

"If I don't have enough to eat, I'll be a loser." Hu Jiaran didn't tolerate her at all, "Hurry up and take a few bites, and I'll wrap up the rest."

"I'm still not satisfied with this. Look at the crappy place you picked."

(End of this chapter)