Chapter 468 Simulation of rare cases (please subscribe)
Author: A lancet
Chapter 468 Simulation of rare cases (please subscribe)
"Polymyositis vera? Are you sure that's the name and not polymyositis?" Zhou Cheng asked Fang Yun after Zhou Cheng, Fang Yun and Yang Yifeng got together.
Yang Yifeng also looked at Fang Yun. This was a patient he happened to receive when Fang Yun was on duty. He was currently living in the department. His main clinical complaint was: muscle weakness and myalgia.
There are red or purple rashes, plaques and edema on the face, neck, chest and hands.
This is actually a chronic disease, but the patient and his family have gone to many places, but no one is willing to accept it. Even those who are willing to accept it have not seen any special effects after treatment for a period of time. Now,
Fang Yun was curious and had enough knowledge, so he thought that this was a rare form of polymyositis in rheumatology, but it had invaded the joints and bones, which was a relatively rare condition. Unexpectedly, after moving in, he discovered that
This is simply not what happened.
Fang Yun said: "Teacher Zhou, when I admitted patients to the hospital, I also considered polymyositis. The same is true for the information I reported to you before."
"But after I went back and checked the information, I found out."
"Polymyositis is an autoimmune disease characterized by muscle weakness and myalgia. The cause is unclear. The main clinical manifestations include symmetric weakness of the proximal limbs, cervical muscles, and pharyngeal muscles, muscle tenderness, and serum enzymes.
A diffuse muscle inflammatory disease characterized by increased muscle mass."
"And because of this type of patients, some patients have malignant tumors before the disease, and about 20% of patients are complicated by other inherent diseases such as lupus erythematosus, scleroderma, rheumatoid arthritis, Sjögren's syndrome, etc."
"So I doubted whether her skin manifestations were really a similar disease, but then, when I was searching the literature, I happened to find the diagnosis of this even rarer disease."
"Polymyoostitis vera is a rare autoimmune disease that mainly affects the skin and muscles. Chronic muscle inflammation and skin manifestations, especially on the face, neck, back of hands, elbows, knees and insteps."
"Then, by collecting some information, I discovered that the current description of it is limited to this."
“Polymyositis rarely causes skin involvement.
"Polymyositis true usually affects proximal muscles, such as the neck, shoulders, and hips, whereas polymyositis can affect both proximal and distal muscles."
"..."
"The current treatment for polymyositis vera is glucocorticoids and immunosuppressants, which are consistent with the treatment of polymyositis. However, there is currently no better dose of the two.
conclusion."
"It is precisely because of this situation that I asked Brother Yifeng how to deal with it in the future." Fang Yun continued to call him teacher Zhou Chengzhou and brother Yang Yifeng.
"You can't find any information? Have you called to ask about the treatment experience or procedures of the hospital that reported similar cases before?" Zhou Cheng asked again.
This is interesting. Polymyositis vera and polymyositis have similar names and similar pathological mechanisms. They are both autoimmune diseases. The drugs for treatment are also similar, but they are the same dose and have no effect.
So, there is no empirical article data or treatment experience as a reference, so you have to explore it yourself?
Yang Yifeng said: "I sent an email and asked one of the doctors. He said that the patient passed away during the follow-up. It should be that the treatment was ineffective."
"The number of patients with this disease is relatively small. The prevalence varies in different regions and countries. The global average prevalence is 2 to 10 people per 100,000 people. In Asia, the prevalence may be even lower.
"
"So, there may only be a few hundred thousand people discovered in the world."
"And because the symptoms and manifestations of this disease are complex and easy to be misdiagnosed or missed, the actual number of patients may be even higher."
"The 5-year survival rate of this kind of patient is 75% to 91%, and the 10-year survival rate is 58% to 83%. You must know that it is not cancer, so its survival rate is quite low."
When Zhou Cheng heard this, he breathed out slowly!
Zhou Cheng was afraid of this kind of disease. There are only about a dozen of them in the world, and he couldn't find it even if he searched for it. If this was the case, he didn't know how many times he would have to simulate it before he could simulate the best treatment plan.
As long as there is still a certain incidence rate in the world, then this will not be a problem for him.
Zhou Chengcheng said: "The prevalence rate is low and patients are absolutely scattered. It is indeed difficult to compile empirical treatment plans. We need to do a little research on this."
"For autoimmune diseases, we need to understand its pathogenesis, especially by asking a rheumatologist for consultation. We will first make a temporary treatment plan, and then slowly adjust it."
"This type of disease shouldn't require surgical intervention, right?"
Yang Yifeng shook his head: "Surgical intervention has not been reported yet, but we do not rule out the possibility that surgical treatment is needed. However, it seems that the number of autoimmune diseases involving surgical treatment is not large."
"Actually, this patient can be sent directly to the rheumatology department. We just need to wait for her antibody test results to come out and let them deal with it. But the number of such cases is very small, and it happens to be a disease in our orthopedics department.
You can also stay and learn more about this aspect."
"Before Fang Yun discovered her, I had never heard of this disease."
Zhou Chengcheng said: "First ask the rheumatologist to come and take a look, and then we can talk."
Zhou Cheng is actually really interested. He hasn't seen the diseases in his blind spot of knowledge for a long time. This situation has lasted for a long time at least.
Although in the past it was because Zhou Cheng did not have the right to be in charge of patients, the diseases he came into contact with were all screened by other professors, but rare diseases always arouse people's interest.
Moreover, now that I have such a small ward and the right to independently carry out diagnosis and treatment activities, then?
Zhou Cheng was not going to let her go with such a rare disease.
It is definitely better for her to stay here than to stay in the rheumatology department. However, the normal diagnosis and treatment procedures must be perfect. Most autoimmune diseases are related to the rheumatology department, so it is better to get in touch.
After that, Zhou Cheng finally returned to the rented house with new expectations.
Fang Yun is still on duty today, so just leave the emergency duty to him.
One thing Zhou Cheng needs to consider is that at present, in addition to the above-mentioned topic he has received, the special education topic he and Gu Huo applied for has also received funds, and the project fund for this research has not been released yet.
Not on the surface.
The main reason is that the project proposed by Zhou Cheng is a bit out of the ordinary and slightly different from the current medical education pattern.
Moreover, Zhou Cheng's education method is still open to question, so he wants to use a less formal, gamified form to appear among a small number of people first, which is equivalent to asking Zhou Cheng to do a pilot project.
Zhou Cheng must also pay attention to this matter.
At the same time, a new simulation started a year later.
【Simulation begins!】
[You already have a good reputation in the industry, have a lot of friends, and already have some status, and then you have developed a strong interest in a certain disease that you are exposed to. 】
[Although you have your own clinical topics and many other topics, you still used your academic influence and professional influence to call on the help of some colleagues across the country, which attracted many people with myosostitis vera.
patient.】
[One and a half years later, you have completed your existing clinical topics, basic topics, published articles, and created a clinical center that has become a great success in your country. It has had a significant impact on the field of orthopedics, and you have begun to make a big noise in the country. 】
[At the same time, you were specially appointed as a professor and became a doctoral supervisor, with multiple PhD and master's degree teaching qualifications! Although you announced at this time that you were about to conquer the research field of unfamiliar diseases, no one doubted your decision. 】
[In the same year, you held a rather grand wedding. The people attending the ceremony and the wedding banquet were all well-known experts and professors from your country and even internationally...]
[Two years later, because the treatment process for unfamiliar diseases is extremely complicated and the treatment effects are difficult to predict, although a few patients have been cured, there are still more patients with poor prognosis, and your reputation has suffered a certain impact.]
[Your university, because of your past achievements and your superior professional abilities, has also given you substantial support. You have begun to develop multiple scientific research centers across the country and adjust and plan treatment plans in multiple centers.
】
[Ten years later, because your team’s core competitiveness is strong enough and it has spent enough money, it finally achieved certain results and progress in the treatment of myosostitis vera.]
[But at this time, someone finally reported the clinical trial you conducted. Some of the patients you initially treated developed end-stage lesions because the amount of treatment was relatively insufficient or redundant. 】
[You were investigated and evidence collected, but because of your rigorous academic style, rich clinical trial experience and preliminary theoretical reserves before the clinical trial was carried out, and the approval of the Ethics Society, you were just stopped from this project. 】
[But you were determined and resolutely chose to resign, go abroad, take your wife and children with you, and establish a clinical trial center abroad. With crazy capital investment, you obtained a large number of original cases...]
【You are experimenting and adjusting.】
[The prognosis of the patients you handle has begun to undergo extreme changes, with one-third recovering and two-thirds having a shorter life expectancy than without treatment.]
[Twenty years later, due to the limitation of the number of cases, your research still has not made much progress. But after you stepped down from your current position, everything you had done before was exposed. 】
[You were condemned, expelled, arrested and imprisoned. Fortunately, your wife and children were sent back to the country before your incident, and the disaster did not harm your family, they were not affected...]
[When you were sixty-one years old, you were revealed to have suffered a mental disorder and committed suicide...]
【Simulation failed!】
[Simulation evaluation: Crazy celebrity! You were famous and wealthy at first, but the behavior you did was extremely evil and deviated from the essence of being a human being. You used the same kind of life as the basic material of the experiment, which was cruel and ultimately useless.
Good death.]
[You can obtain one of the following skills]
[Experience in diagnosis and treatment of myosostitis vera (Pioneering - Mastery)]
[Others: None.]
After Zhou Cheng finished reading it, his heart was like water.
These words in the simulator world can hardly change his mood now.
Because Zhou Cheng, who is in the real world, knows that his research results under extreme circumstances in the simulator world, as well as the patients he has to deal with during the research, are actually the audience in the real world under the accumulation of time.
In other words, even if you don't do this in the simulator world, in reality, there must be a sufficient number of people to support the corresponding experiments, and in the end, reliable results can be obtained.
Therefore, this simulation is just an experience, and it is such an unfettered experience.
If it were in reality, there might be even more sacrifices!
If it doesn't work the second time, the main reason is that the number of cases is too small.
Medicine, as a whole, is extremely complex and complicated. With my current accumulation, if I want to change my career to an unfamiliar field, I may not be able to break through the final hurdle in my life. This doesn't matter.
There are many geniuses in the world. Even if the chance is one in a million, there are still tens of thousands of geniuses in the world, and this is true in every era and every moment.
However, research on medical treatments is still progressing slowly.
【……】
[Ten years later, you have become the top orthopedic professor in the country. Your professional abilities and scientific research capabilities have reached their peak. However, all the students you have accepted have left your team, and no one continues to study with you.
doctoral degree.]
[Furthermore, your doctoral students have also left your unit to work in other units. 】
【……】
[Twenty years later, your research results will finally be effective. When your research results are successful, there is still no response. All journals have banned you, and all publishers have kept their distance from you, because you
Already infamous, like a rat crossing the street...]
[When the treatment plan matures, you quit all medical-related jobs. You learn from your friends, record your research results on the Internet, use stories and jokes as carriers, and then spend the rest of your life in retirement...
…]
[When you were eighty-seven years old, you had a whole family of descendants, and you died without any illness.]
[A hundred years later, when a medical friend accidentally applied your joke story to clinical practice, the treatment plan was spread. But your name is still lost in the vast river of history. 】
[The treatment plan was finally named after your pseudonym—Treatment Plan for Passenger Myososteitis Multiplex.]
[Simulation ends...]
Zhou Cheng was slowly sipping tea at the moment. After refining the relevant simulation memories and results, Zhou Cheng began to slowly think about how to make this plan public in a more reasonable and effective form.
, and use it on the patient in charge of his department.
Creating something out of nothing is obviously not possible...