This doctor has a system

Chapter 319 300. Is the efficiency of Nature magazine so high?

"Look, CT shows diffuse small nodules in both lungs with unclear edges. They are mainly distributed in the lower fields of both lungs. They are also accompanied by excessive lung expansion. Bronchiectasis occurs in the middle lobe and lingual lobe, showing a double-track sign. and cystoid changes.”

"Diffuse panbronchiolitis cannot be ruled out."

"Diffuse panbronchiolitis?" Bu Zhengyang was obviously a little confused. He used to practice cardiology. Although the heart and lungs are not separated, he is definitely not as professional as a doctor with a background in respiratory medicine.

Diffuse panbronchiolitis is an idiopathic, diffuse, inflammatory and obstructive airway disease that mainly affects the respiratory bronchioles of the lungs. It can manifest as chronic cough, sputum production, and exertional dyspnea. , accompanied by airflow restriction.

It was first proposed by Japanese scholar Homma et al. in 1969, and was not recognized by international colleagues until the early 20s.

This disease is easily missed or misdiagnosed, and is often hidden in chronic bronchitis, bronchiectasis, bronchial asthma, and chronic obstructive pulmonary disease.

As for why Japanese scholars first discovered it, this is because the disease is prone to occur in East Asia, with Japan being the most common and sporadic in Europe and the United States.

"You mean the previous diagnosis of chronic bronchitis was wrong?" Bu Zhengyang asked.

"It can't be said that it's completely wrong." Gao Feng considered, "He has chronic bronchitis, but this is obviously not the main reason for his wheezing symptoms."

In fact, Mr. Li was treated as chronic bronchitis every time he had a wheezing attack, but the effect was not good.

It often takes a long time to get relief, and he will get sick again at the slightest disturbance.

This is related to not finding the right treatment direction.

Generally, when chronic bronchitis attacks, many doctors will use anti-infective, antispasmodic, and antiasthmatic treatments. For patients like Uncle Li, the application of hormones is certainly unavoidable.

Uncle Li was originally relatively thin, but after taking hormones from time to time in the past few years, he has obviously gained weight. This is related to the fact that glucocorticoids can cause water and sodium retention in the body.

But in the eyes of my wife, this is the result of her careful care.

"Look at the fat and white thing I raised for you!"

The treatment plan for diffuse panbronchiolitis is different from that of chronic bronchitis. The main treatment for this disease is oral low-dose, long-term macrolide drugs.

Macrolide antibiotics can not only treat respiratory tract infections, but also have anti-inflammatory and immunomodulatory effects.

It can significantly improve patients' clinical symptoms and lung function indicators, promote imaging improvement, and improve survival rates.

"What do you mean? I don't have chronic bronchitis?" Uncle Li looked confused.

"Chronic bronchitis also exists, but the most important thing that causes you to wheeze is the diffuse panbronchiolitis we just told you about." Gao Feng explained to him, "This disease requires you to take medicine for a long time."

Most patients will experience significant improvement after taking oral macrolide antibiotics for 2 to 3 months, but the medication cannot be stopped early and the medication needs to be continued for 6 months to evaluate the efficacy.

The drug can be stopped after 2 years of treatment and the condition has stabilized. For patients who relapse after drug withdrawal, the drug is still effective. For patients with extensive bronchiectasis and progressive respiratory failure, the treatment course is not limited to 2 years if the treatment is effective.

"In its early days, diffuse panbronchiolitis was considered a bronchial disease with a poor prognosis, and when patients were not treated with erythromycin, the 5-year survival rate was only 42%."

“The 5-year survival rate of patients with Pseudomonas aeruginosa infection is only 8%, but with the widespread use of macrolide drugs, especially erythromycin, the cure rate of the disease has significantly improved. "Gao Feng preached to the students of Guipei.

This batch of regular trainees all look dull and clumsy in training. Very uncomfortable.

"According to statistics, the 5-year survival rate after treatment with erythromycin has increased to 93.4%, and the annual mortality rate has also dropped from 10% to about 2%."

"So, after the diagnosis of diffuse panbronchiolitis is confirmed, what should we do?" Gao Feng asked the students.

"Tell me about the boy wearing glasses."

"Yeah." The male standard Pearson hesitated, "Put on hormones?"

Gao Feng suspected that he came to cause trouble on purpose.

“Initiate macrolide drug treatment as soon as possible!”

"I just talked so much, did I mention hormones?" Gao Feng fell into self-doubt.

Bu Zhengyang glared at this classmate dissatisfied, "Idiot!" As long as you just heard a sentence, you won't be unable to answer this question.

After explaining it carefully, he only got 2 skill points, which were obtained from Bu Zhengyang, which made Gao Feng very discouraged.

"You are the worst class I have ever taught!"

Uncle Li didn't believe Gao Feng's words at first. He had seen his problem in several hospitals, and every doctor said it was chronic bronchitis.

This doctor surnamed Gao looks too young and not even bald, so he always feels unreliable.

"Is there something wrong with you?" His wife was speechless to him, "Shorter hair means better skills? What kind of crooked truth is this?"

"What do you know? In this profession of doctors, the balder you get, the stronger you get!"

Uncle Li contacted his son, and the latter rushed back from the capital.

"I'll take you there to have a look." The son is very positive. His father usually seldom troubles him, but this time he said he must take him for another diagnosis.

The family stayed near Xhe Hospital for two days. There were too many patients coming for treatment. In the end, the son spent money to buy a scalper account.

"Doctor, please take a look. The doctor over there said this is what I am."

"Diffuse bronchiolitis." The son added from the side.

"That's right! Diffuse bronchitis." Mr. Li said, "In the past, it was treated as chronic bronchitis."

"Oh." The doctor at the clinic looked at his chest CT carefully, "Do you have chronic sinusitis?"

"Have."

"Doctor, this is an examination done by the hospital over there. Take a look." Uncle Li's son took out the medical record and handed it to the doctor.

"The titer of the cold agglutination test increased (> 1:64)." The attending doctor turned a few pages and saw this result, and he did not read further.

"It's diffuse bronchitis. Your diagnosis is very clear."

"Just go back and take the medicine as instructed."

"I knew I wouldn't come." Uncle Li suddenly regretted it. A scalper account cost 800 yuan and cost the whole family a trip.

"You can't say that. We don't have to worry about coming here to take a look." The son comforted.

The follow-up treatment went smoothly. After taking erythromycin orally, Uncle Li's wheezing symptoms gradually eased, his activity tolerance increased significantly, and the frequency of hospitalization was greatly reduced. In routine medical diagnosis and treatment, misdiagnosis is inevitable.

The first thing most doctors think of is definitely general illness, because we are all ordinary people. So sometimes empirical errors are made.

Just like the case of Uncle Li, he has a long history of smoking. Imaging shows emphysema and decreased lung function. The main symptoms at onset are wheezing, which is consistent with the onset of chronic bronchitis.

Therefore, many doctors will not explore further.

Is this an irresponsible behavior?
The answer is obviously no.

Would it be beneficial to the patient to delve deeper? It is definitely beneficial, but it means spending more energy and spending more money.

This is also unacceptable to ordinary people.

Just like fever, runny nose, and fatigue, most people have a cold and can be cured by taking some medicine. But there are also some people who are complicated by myocarditis, and they will even curl their hair while you are not paying attention.

But if everyone rules out myocarditis when they come, the cost will be a bit high.

Patients themselves are very dissatisfied with the current medical expenses, and doctors' jobs are not easy either. I can only say that it is not easy for both parties.

After returning home, Gao Feng began to conceive of his third article: the genome and transcriptome evolution of primary tumors and metastases.

This study investigated intratumoral transcriptomic diversity in multiple non-small cell lung cancer tumors using paired whole-exome and RNA-sequencing data.

Analysis of 947 tumor regions representing primary and metastatic disease and 96 tumor-adjacent normal tissue samples revealed that the transcriptome is a major source of phenotypic variation.

Gao Feng also combined multiple statistical methods using genomic and transcriptomic variables to link metastatic seeding potential to the evolutionary context of increased mutation and proliferation within the primary tumor region.

These results should highlight the interplay of the genome and transcriptome in influencing ITH, lung cancer evolution, and metastasis.

At present, because the specific data has not been completely calculated, the final result cannot be revealed yet.

Xiong Huaxin is already crazy busy here. The whole exome and RNA sequencing data are too cumbersome, and after in-depth statistics, he found that some of the previous data were still wrong.

This means that nearly 20% of the data needs to be re-entered, which is a lot of work.

"Half a month, half a month must be completed." Xiong Huaxin said.

"Half a month is unrealistic. You don't know that this is not a matter of re-entering." Senior Brother was very worried, "The sequencing data also needs to match the tumor area. I think it will take at least a month."

“Can working three shifts shorten the time?”

"Three shifts?" Senior Brother Xiong Huaxin was stunned for a moment, "What do you mean?"

"It literally means that we can divide people into three groups." Xiong Huaxin said, "Each person will lead a group to fully utilize the time and laboratory."

Then more manpower is needed, senior brother thought as he touched his chin.

But this is not difficult for them. Firstly, they have sufficient funds. Secondly, three-legged toads are hard to find these days, and two-legged scientific research workers are all over the streets.

Many people also think that Academician Bao's laboratory is plated with gold, which is the best of both worlds.
-
Z University Pharmacy Laboratory, afternoon

"It's snowing!" An employee from the south suddenly shouted excitedly.

Wang Liang next to him was startled, and the dropper and pipette in his hand was almost thrown out.

"Isn't it just snowing? Why are you so excited?" He said dissatisfiedly, "You can cry like this when you get money."

His colleague was too lazy to pay attention to him and hurried downstairs with his mobile phone. He wanted to take pictures and post them on WeChat Moments.

Wang Liang curled his lips. Snowing is very common for northerners. Which year doesn't snow? It's a little late this year.

He doesn't like snow. When he was a child, it snowed heavily and the road became very slippery after it froze. His balance was not very good and he accidentally fell. His butt was broken into eight pieces and his fibula was fractured.

"Dear, it's snowing." His girlfriend Liu Fang sent Wang Liang a message, "It's so beautiful."

"I also discovered it. The scattered snowflakes are like dancing elves." Wang Liang quickly replied, "It would be nice if you were by my side at this time. We can walk in the snow and grow old together."

"These Southerners just haven't seen the world." Someone laughed. "They probably haven't seen snowflakes very much."

"Who do you think has never seen the world?" Someone was dissatisfied. He was from Guangdong. "You haven't seen many things in our south!"

"You said."

"Have you ever seen a cockroach as big as a palm? The kind that spins and flies!"

This is indeed a specialty of the south. The cockroaches in the north are relatively small, but the ones in the south grow up on what they eat, and they grow to scary sizes.

After the Cantonese man finished speaking, he quickly went downstairs, started running in the snowflakes, and howled.
-
"The evolution of lung cancer metastasis?" Philip from Nature magazine read the title of the article softly.

"No, he submitted another article!" A colleague smacked his lips, "It seems he really wants to make a series."

Are you so confident? Philip thought to himself. It is not easy to publish articles continuously in a short period of time. To be precise, it is as difficult as climbing to the sky.

Phillip didn't know where the other party's confidence came from, but this did not prevent him from carefully reviewing the manuscript. As an editor, his job is to find valuable articles among the many submissions.

As for who wrote this article, he actually doesn't care.

As long as you are capable, what you write is innovative and reaches the level of publication in this journal, you will be favored by him.

"Metastatic disease is the cause of most cancer-related deaths. A longitudinal evolutionary analysis of 421 non-small cell lung cancer (NSCLC) tumors from 126 patients recruited with metastatic disease was performed and compared with"

"The analysis showed that in 25% of cases, metastases differentiated early before the last clonal scan of the primary tumor, with early differentiation being more abundant."

"Single-region primary tumor sampling resulted in 83% of late-stage divergent cases being misclassified as early-stage, highlighting the importance of widespread, associated polyclonal dissemination found in 32% of cases."

"Primary lymphoid amplification occurs in less than 20% of cases, possibly reflecting positive selection."

It took Philip nearly 4 hours to read this article, during which he also consulted a lot of literature for support.

"Such a large sample size is really rare." He told his colleagues, "The article is also very innovative, and many of the things in it are applied to technologies that have only been developed in recent years."

He immediately sent the article to several independent reviewers.

"Is the efficiency of Nature magazine so high?" Gao Feng looked at the reply email in his mailbox and fell into deep thought. The other party told him that the second article could be published together with the first article in the next issue.

(End of this chapter)