Chapter 171 How confident are you?
As usual, Zhang Yang extracted the drug reward before exiting the simulator.
With the introduction of a large amount of patented technology and drug knowledge into his mind, he also gained a deeper understanding of the effect of the "nano nodule developer".
Lung cancer is roughly divided into four types:
Lung adenocarcinoma, which is the most common type of lung cancer, accounts for about 40% of lung cancers.
Squamous cell carcinoma, referred to as squamous cell carcinoma, is a malignant tumor caused by the deterioration of squamous epithelial tissue;
Squamous cell carcinoma is not only found in lung cancer, but also in many tissues covered by squamous epithelium such as the skin, oral cavity, and esophagus. Squamous cell carcinoma can occur in any organ.
The remaining two types are large cell lung cancer and small cell lung cancer.
But no matter what kind of lung cancer it is, after the appearance of lung nodules and cancer cells, it will secrete a substance that is completely different from normal cells.
The "Nano Nodule Developer" provided by the system covers markers secreted by four types of cancer cells,
As long as nodules appear, as long as any type of cancer cells appear, they can be identified through the fluorescent reaction produced by the "nodule developer".
Thinking of this, Zhang Yang couldn't wait to start testing the effect of this "nodule developer", but he soon calmed down.
"Nano nodule developer" can only identify cancer cells and produce a reaction, but if you want to display them through imaging, you need to modify the CT machine and install a device that can identify fluorescent reactions. Special spectrum.
No.
Instead of carrying out the matching transformation of the CT machine, we should first have a CT machine.
"Would you like to buy one yourself?"
Zhang Yang's thoughts suddenly paused. It's not that Qingshan Pharmaceutical cannot afford it, but if it buys one and puts it in the Qingshan Pharmaceutical Drug Research Center, where will the patients come from?
After thinking for a moment, Zhang Yang shook his head:
“It seems that we have to trouble Director Zhou to see if the Third People’s Hospital can provide a CT machine for modification so that it can be used Let’s test the effect of ‘nano nodule developer’”
“Because only hospitals have enough patients to successfully pass the clinical trial verification”
"In addition, we need to contact the CT machine manufacturer to ask for help in adding a special spectrum that can identify fluorescence reactions;
Although I have technical drawings for supporting improvements, after all, Qingshan Pharmaceutical knows nothing about medical devices. . ”
“Yes, that’s the idea!”
Zhang Yang’s idea gradually became clear, and he went to the patent office in person early the next morning to submit the “Nano Nodule Developer” and the supporting “CT A patent application was submitted for "Special Spectral Imaging Technology".
A few days later, when the preliminary review of the patent was over, he immediately came to Dean Zhou’s office and expressed his hope to provide a CT machine and modify it to conduct clinical trials of "Nano Nodule Developer" idea.
After the words fell, Dean Zhou was not stunned because Zhang Yang asked to borrow a CT machine. Instead, he was surprised by the "nodule developer" mentioned by Zhang Yang.
"Zhang Yang, you are saying that you have developed a imaging agent that can identify whether pulmonary nodules are benign or malignant?"
"That's right."
Zhang Yang Nods:
“But in addition to the developer, a CT machine is also needed for supporting imaging, and the CT machine needs to be additionally modified for spectrum... So, I just thought of you, and I am here to trouble you.”< br>
"Huh..."
Exhaling heavily, Dean Zhou agreed immediately without any hesitation.
Of course,
It was also thanks to the good relationship between Dean Zhou and Zhang Yang that he dared to lend Zhang Yang a CT machine worth millions and millions so readily for modification.
You know, there are only four CT machines in the entire Chengdu Third People's Hospital. If one is taken out for renovation, the daily CT shooting volume will inevitably decrease, and these are all income!
"By the way Zhang Yang, for the modification you just mentioned, do you need to contact the CT machine manufacturer or do you modify it yourself?"
"You need to contact the CT machine manufacturer, which may require you to contact Zhou Yuan, and What types of CT machines are available in our hospital now? What manufacturers are they? ”
"Let me think about it...it seems that the four are the latest dual-source CT machines from Siemens. Do you think they are suitable?"
"It should be suitable."
"Okay, then I will contact the Siemens manufacturer tomorrow to see how to modify it according to your requirements.”
"Okay! Thank you, Dean Zhou!"
Zhang Yang and Dean Zhou quickly discussed the details of the CT machine transformation, while on the other side,
Beijing, nine o'clock in the evening, the night was dark Next, darkness enveloped the entire city.
Thoracic Surgery Clinic, Air Force General Hospital.
According to normal circumstances, at nine o'clock in the evening, the outpatient department of the thoracic surgery department should be dark, and the doctors have all gone home from get off work.
But at this moment, the lights were bright in a small conference room in the thoracic surgery outpatient department, and even the entire corridor was brightly lit.
After a while, one, two, and three middle-aged doctors hurriedly walked through the corridor and walked into the conference room.
At this time, if there is someone who has a little knowledge of domestic thoracic surgery, his eyes will be wide open and he will be surprised. The three doctors who walked into the conference room are:
301 Hospital Thoracic Surgery Chief surgeon - Director Hao.
Director Li, professional president of Thoracic Surgery of Beijing Medical Association.
Director Qiao, chief physician of the Thoracic Surgery Department of Union Hospital.
You know, these three people can be said to be the top experts in thoracic surgery in the country!
It’s so late now, what are three top experts doing suddenly gathering here? !
In the conference room, a middle-aged man wearing an executive jacket and black-rimmed glasses had been waiting for a long time. When he saw three doctors arriving, he stood up and said politely:
" Director He, Director Li and Director Qiao, thank you very much for coming here after get off work. Thank you very much.”
"Secretary Bai, you're welcome. This is what we should do."
"Okay, thank you all, please sit down."
Secretary Bai, a middle-aged man, greeted the three The person sat down and immediately took out a laptop from the computer bag he carried with him:
“I specially bothered three professors to come over today, mainly because I want them to help me. Looking at a CT image, it’s about a pulmonary nodule.”
“The three of them are the top professors of thoracic surgery in the country. I won’t talk too much about their profession, but... today’s film is about it. The identity of the patient is somewhat special. I hope you will not disclose any information or condition after seeing it, and strictly abide by the confidentiality regulations, okay?”
Confidentiality regulations?
The expressions of the three of them instantly became serious.
However, in fact, when seeing the consultation between the three people, everyone had vaguely guessed that the identity of the patient was special, and they were mentally prepared in advance.
“Secretary Bai, we all know this, don’t worry.”
“Okay!”
After emphasizing the confidentiality regulations, Secretary Bai no longer hesitated, and then gently pushed the laptop computer that saved the patient's CT images in front of the three experts, and continued:
"I just said it directly, this It is the CT report of Mr. Zhang, the head of an important department under our "Manned Moon Landing" project. "
" Mr. Zhang is 69 years old this year, but he is still an absolutely important expert and project leader in this field. Man, is the 'manned moon landing' project An important part! "It can be said that Mr. Zhang's current physical condition is not only related to his own life safety, but also has a decisive impact on the progress of the entire country's manned moon landing project!"
< br>
“Three days ago, when we did a routine physical examination on Mr. Zhang, we found some abnormalities in his CT images; multiple doctors from our Air Force Hospital analyzed his CT images, but there were huge differences! ”
"Some doctors believe that the nodule on Zhang Lao's lung is a malignant tumor and needs to be surgically removed immediately, but some doctors suggest that it may be a benign tumor and can be observed further!"
"We can't make up our minds either. So I specially summoned three of the top experts in the country to take a look and give some advice!”
“Okay, we’ll do our best!”
The three doctors all said it. Nodding, he also instantly felt tremendous pressure.
Director Hao from the 301 Hospital was the first to turn his attention to the CT images and began to analyze them carefully.
The CT image in front of me is a typical picture of multiple pulmonary nodules in both lungs.
There is one solid nodule in the left lung and four ground glass nodules in the right lung. There are a total of five pulmonary nodules in the lungs.
Let’s start with the first solid nodule in the left lung.
Solid nodules have high density and are the most malignant. However, many solid nodules are often "scars"-like things formed by pulmonary fibrosis, tuberculosis, and lung damage, so they are not necessarily Malignant,
On the contrary, most solid nodules are benign.
However, since Secretary Bai provided the patient's CT images in the past three years, it can be seen that this solid nodule suddenly appeared this year!
This is a new nodule!
Director He, Director Li and Director Qiao did not dare to neglect and compared the CT images from last year seriously. After about five minutes, the three of them had a unified understanding of the first solid nodule in the left lung. in conclusion.
"Director Hao, I think the solid nodule in the left lung has a clear border and no thorns, and the size of the nodule is only 5mm. It is recommended that follow-up observation be carried out. What do you two think?"
"I I think so too.”
"No problem."
After looking at the first one from the left lung, the three experts then focused their attention on the right lung.
There are four ground glass nodules in the right lung, starting from the first one, the first, the second, the third...
Three experts carefully compared the patient's symptoms last year CT images, while also constantly discussing.
Soon, the first three ground-glass nodules on the right lung also reached the unanimous conclusion of all three people.
Compared with last year's CT image, the three ground-glass nodules have not become significantly larger, and their shapes are regular.
At the same time, the three ground-glass nodules are still relatively small in size, respectively 6mm and 6.8mm. ,7.2mm.
"I still recommend continued follow-up for these three. There is no need for surgery!"
"That's right!"
Everything seems to be going well, though.
When the three of them saw the last ground glass nodule in the right lung, they frowned and instantly understood why Secretary Bai just said that many doctors at the Air Force Hospital were very divided.
First of all, the ground glass nodule in the right lung is very deep and is a very bad location!
What is deep position?
In layman's terms, if the pulmonary nodule is on the surface of the lung, or on a shallower surface, then just cut off part of the surface lung tissue.
But,
What should we do if the pulmonary nodule grows in the middle of the lung lobe, is deep in the lung tissue (not on the surface), or is right next to the pulmonary vein?
Then we can only remove a large area!
And this means cutting off at least one-third of the lung lobes, which will undoubtedly have a great impact on the patient's lung function.
If the pulmonary nodule is really a malignant tumor, it’s okay. If it is a benign tumor, who will be responsible if the wrong one is cut!
The price is too high!
The most troublesome thing is:
It is really difficult to judge whether the fourth ground glass nodule is benign or malignant!
Currently, doctors judge whether pulmonary nodules are benign or malignant in medicine through imaging and their own clinical experience.
To be more detailed, first observe the size of the nodule:
The larger the nodule, the more likely it is to be malignant, especially the nodules that grow every year, which are more likely to be malignant tumors.
Second: observe the nodule morphology and structure.
Benign nodules are regular in shape and have smooth edges; malignant nodules are often irregular in shape, with lobes, burrs, and pleural traction signs on the edges.
But compared to last year’s image, the fourth ground-glass nodule in front of me has grown from 7.5mm to 8.3mm, showing signs of expansion, which is consistent with the characteristics of malignant tumors that continue to grow.
However, in terms of morphological structure, there is no typical malignant nodule shape. The border is still clear, and the lobes and burrs are not obvious.
In other words, this is an atypical ground glass nodule, which is difficult to judge!
The discussion time for the last nodule far exceeded the time for the previous four nodules.
After thirty minutes, the expert group composed of Director He, Director Li and Director Qiao barely came up with a conclusion. A conclusion recognized by all three.
"Secretary Bai, we have finished analyzing the patient's CT images. Let's briefly talk about our conclusions."
"Okay!"
Secretary Bai looked solemn and serious. Nod.
"First of all, we think the first solid nodule in the left lung is more likely to be benign. It is currently only 5mm. It is recommended to follow up and do not need treatment for the time being."
"The first, second and third nodules in the right lung We also believe that resection is not necessary for the time being. The biggest difference is the fourth nodule.” There is no iconic shape of a malignant nodule, but it has grown significantly compared to last year's image.
Moreover, the location of the nodule is densely packed with blood vessels. Once it develops into the 'micro-invasive' stage , it is very likely that the cancer cells will be transferred to other places quickly through the capillaries, causing more serious consequences!”
“So!”
"Although thoracotomy is required and the risks are relatively high, after comprehensive consideration, we still believe that it is necessary to perform surgery now!"
"The advantages outweigh the disadvantages."
Surgery?
Secretary Bai on the side felt a thump in his heart, then took a deep breath and whispered:
"How sure are you?!"
"With surgery, there is at least 95% certainty."
"I mean, how certain is it that the last nodule is a malignant nodule?!"
After the words fell, Director Hao headed The three people fell silent immediately.
At this moment, Secretary Bai exhaled slightly and said in a deep voice:
"I'm not trying to embarrass you. Everyone knows that Mr. Zhang is already 69 years old and can no longer stand the trouble. ! ”
"Moreover, the aerospace project currently in charge of Mr. Zhang is at its most critical period, and the surgery will inevitably affect the progress at this time!"
"Of course, if the surgery is indeed necessary, we are willing to do it, even at the expense of delaying the progress of the project. To protect Mr. Zhang’s life, we want to be 100% sure!”
“You three, are you 100% sure?”
(End of this chapter)