After being fired, I became the light of medicine

Chapter 171 How Sure Are You?

As usual, Zhang Yang collected the drug reward before exiting the simulator.

As a large amount of patented technologies and drug knowledge came into his mind, he also had a deeper understanding of the pharmaceutical effect of "nano-nodule contrast agent".

Lung cancer is roughly divided into four types:

Lung adenocarcinoma is the most common type of lung cancer, accounting for approximately 40% of lung cancers.

Squamous cell carcinoma, referred to as SCC, is a malignant tumor caused by the deterioration of squamous epithelial tissue;
Squamous cell carcinoma occurs not only in lung cancer, but also in multiple tissues and organs covered with squamous epithelium, such as the skin, mouth, and esophagus.

The remaining two are large cell lung cancer and small cell lung cancer.

But no matter which type of lung cancer it is, it will secrete a substance that is completely different from normal cells after lung nodules and cancer cells appear.

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 "nodule developer" that produces a fluorescent reaction.

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 reactions, but if you want to display them through imaging, the CT machine needs to be modified to match it and equipped with a special spectrum that can identify fluorescent reactions.

wrong.

Instead of carrying out supporting modifications to the CT machine, we should first have a CT machine.

"Buy one yourself?"

Zhang Yang's thoughts suddenly paused. It's not that Qingshan Pharmaceutical can't afford it, but if he buys one and places it in the Qingshan Pharmaceutical Drug Research Center, then where will the patients come from?

After thinking for a moment, Zhang Yang shook his head:
"It seems that I have to trouble President Zhou for this matter. I want to see if the Third People's Hospital can provide a CT machine for modification so as to test the effect of 'nano-nodule contrast agent'."

"Because only hospitals have enough patients, it is possible to successfully pass clinical trial verification!"

“In addition, we need to contact the CT machine manufacturer to ask them to help add a special spectrum that can identify fluorescent reactions;
Although I have technical drawings for the improvements, Qingshan Pharmaceutical knows nothing about medical devices.”

"Yes, that's the idea!"

Zhang Yang's ideas gradually became clear, and he went to the Patent Office in person the next morning to submit patent applications for the "nano-nodule developer" and the accompanying "CT special spectral imaging technology."

A few days later, after the initial patent review was completed, he came to Dean Zhou's office and proposed the idea of ​​providing a CT machine and modifying it for the clinical trial of "nano-nodule contrast agent".

After he finished speaking, Dean Zhou was not stunned by Zhang Yang's request to borrow a CT machine. Instead, he was surprised by the "nodule contrast agent" mentioned by Zhang Yang.

"Zhang Yang, are you saying that you have developed a contrast agent that can identify whether lung nodules are benign or malignant?"

"Yes."

Zhang Yang nodded:
"But in addition to the developer, a CT machine is also needed for matching imaging, and the CT machine needs to be modified for spectrum... So, I thought of you and am sorry to bother you."

"call……"

Exhaling heavily, Dean Zhou agreed immediately without hesitation.

of course,

This was also thanks to the good relationship between Dean Zhou and Zhang Yang, so he dared to lend the CT machine worth millions to Zhang Yang so readily for the transformation.

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 scan volume will inevitably decrease. These are all income!

"By the way, Zhang Yang, the modification you mentioned just now, do you need to contact the manufacturer of the CT machine or do you want to modify it yourself?"

"We need to contact the CT machine manufacturer. You may need to contact Dr. Zhou. Also, what types of CT machines does our hospital have now? What manufacturers do they come from?"

"Let me think about it... It seems that all four of them are Siemens' latest dual-source CT machines. Do you think they are suitable?"

"It should be suitable."

"Okay, then I'll contact Siemens for you tomorrow and see how to modify it according to your requirements."

"Okay! Thank you, Dean Zhou!"

Zhang Yang and Director Zhou quickly discussed the details of the CT machine modification, while on the other side,
In the capital, at nine o'clock in the evening, night fell and darkness enveloped the entire city.

Department of Thoracic Surgery, Air Force General Hospital.

Normally, at nine o'clock in the evening, the outpatient department of thoracic surgery should be pitch dark, and the doctors would have gone home after get off work.

But at this moment, the lights in a small conference room of the Thoracic Surgery Outpatient Department were bright, and even the entire corridor was brightly lit.

After a while, one, two, and three middle-aged doctors hurriedly crossed the corridor and walked into the conference room.

At this time, if there was anyone who had some knowledge of domestic thoracic surgery present, his eyes would certainly widen in surprise. The three doctors who walked into the conference room were:

Chief Physician of the Department of Thoracic Surgery at the 301 Hospital - Director Hao.

Director Li, Chairman of the Thoracic Surgery Department of the Beijing Medical Association.

Director Qiao, chief physician of the Department of Thoracic Surgery at 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, why are three top experts suddenly gathered here? !

In the conference room, a middle-aged man wearing an executive jacket and black-framed glasses had been waiting for a long time. When he saw the three doctors coming, 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 too polite. This is what we should do."

"Okay, thank you everyone, everyone please take a seat."

The middle-aged man, Secretary Bai, asked the three of them to sit down, and then took out a laptop from his computer bag:

"I've specially troubled three professors to come here today, mainly because I want you to help me look at a CT scan of a lung nodule."

"You three are all top professors of thoracic surgery in China. I won't waste any time on your expertise, but... the patient in today's film has a special identity. I hope that after watching it, you will not leak any information or condition to the outside world and strictly abide by the confidentiality regulations. Okay?"

Confidentiality policy?

The three of them looked serious in an instant.

However, in fact, when everyone saw the three people consulting, they had already vaguely guessed that the patient's identity was rather special, so they were mentally prepared in advance.

"Secretary Bai, we all know this, don't worry."

"it is good!"

After stressing the confidentiality clause, Secretary Bai no longer hesitated and gently pushed the laptop computer containing the patient's CT images to the three experts and continued:

"I'll just say this directly. This is the CT report from Mr. Zhang, the head of an important department under our 'Manned Lunar Landing' project."

"Mr. Zhang is already 69 years old this year, but he is still an absolutely important expert and project leader in this field, and an important part of the 'manned lunar landing' project!" "It can be said that Mr. Zhang's current physical condition is not only related to his own life safety, but also has a significant impact on the progress of the 'manned lunar landing' project of the entire country!"

"Three days ago, when we performed a routine physical examination on Mr. Zhang, we found some abnormalities in his CT scans. Several doctors at our Air Force Hospital analyzed his CT scans but had very different opinions!"

"Some doctors believe that the nodules on Mr. Zhang's lungs are malignant tumors and need to be removed immediately by surgery, but some doctors suggest that they may be benign tumors and can be observed for a while!"

"We couldn't make up our minds either, so we specially called three of the country's top experts to take a look and help give us some advice!"

"Okay, we'll try our best!"

As soon as the words came out, the three doctors nodded in unison, and at the same time, they instantly felt a huge pressure.

Director Hao of the 301 Hospital was the first to focus on the CT images and began to analyze them carefully.

The CT image in front of you is a typical picture of multiple lung nodules in both lungs.

There is one solid nodule in the left lung and four ground-glass nodules on the right side, for a total of five lung nodules.

Let’s start with the first solid nodule in the left lung.

Solid nodules have a high density and are the most malignant. However, many solid nodules are similar to "scars" formed by pulmonary fibrosis, tuberculosis, and lung damage, so they are not necessarily malignant.
On the contrary, solid nodules are mostly benign.

However, since Secretary Bai provided the patient's CT images from 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 delay and carefully compared the CT images from last year. About five minutes later, the three of them reached a unanimous conclusion on the first solid nodule in the left lung.

"Director Hao, I think the solid nodule in the left lung has clear boundaries and no thorns, and the nodule is only 5mm in size. I suggest that we follow up and observe it. What do you think?"

"I think so too."

"no problem."

After examining the left lung, the three experts then turned their attention to the right lung.

There are four ground-glass nodules in the right lung, starting from the first one, the first, the second, the third...

The three experts carefully compared the patient's CT images from last year and kept discussing.

Soon, the three people reached the same conclusion on the first three ground-glass nodules on the right lung.

The three ground-glass nodules did not grow significantly larger than last year's CT images, and their shapes were regular.
At the same time, the three ground glass nodules are still relatively small in size, namely 6mm, 6.8mm, and 7.2mm.

"I still recommend continuing follow-up for these three. There is no need for surgery!"

"That's right!"

Everything seemed to be going well, though.

When the three of them saw the last ground-glass nodule in the right lung, they frowned immediately and instantly understood why Secretary Bai had just said that there were huge differences of opinion among the doctors in the Air Force Hospital.

First of all, the ground glass nodule in the right lung is located very deep, which is a very bad location!

What does deep position mean?
In simple terms, if the lung nodule is on the surface of the lung, or at a shallower position on the surface, then you can simply cut off a portion of the surface lung tissue.

but,

What if the lung nodule grows in the middle of a lung lobe, deep in the lung tissue (not on the surface), or right next to a pulmonary vein?
Then the only option is large-scale resection!
This means that at least one-third of the lung lobe must be removed, which will undoubtedly have a great impact on the patient's lung function.

If this lung nodule is really a malignant tumor, it would be easy to deal with. But if it is benign, just cut it off. If you cut it wrong, who will be responsible?
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 determine whether lung nodules are benign or malignant based on imaging combined with their own clinical experience.

To be more specific, first observe the size of the nodule:

The larger the nodule, the more likely it is to be malignant, especially a nodule that grows larger every year is likely to be a malignant tumor.

Second: observe the morphology and structure of the nodules.

Benign nodules have regular shapes and smooth edges, while malignant nodules often have irregular shapes, with lobes, burrs, and pleural traction signs on the edges.

However, compared with last year's images, the fourth ground glass nodule in front of us has grown from 7.5mm to 8.3mm, showing signs of expansion, which is consistent with the characteristic of malignant tumors continuing to grow.

However, in terms of morphology and structure, it does not show the typical morphology of a malignant nodule. The boundaries are clear, and the lobes and burrs are not obvious.

In other words, this is an atypical ground glass nodule and is difficult to judge!
The discussion time for the last nodule was much longer than that for the previous four nodules.
After a full thirty minutes, the expert group consisting of Director He, Director Li and Director Qiao finally came to a conclusion that all three of them agreed with.

"Secretary Bai, we have analyzed the patient's CT images. Let us briefly state our conclusions."

"it is good!"

Secretary Bai looked solemn and nodded heavily.

"First of all, we think the first solid nodule in the left lung is more likely to be benign. It is only 5mm at present. We recommend follow-up and no treatment is needed for the time being."

"We also think that the first, second, and third nodules in the right lung do not need to be removed for the time being. The biggest disagreement is about the fourth nodule."

"We think surgery should be considered. Although the morphology and structure do not show the hallmarks of a malignant nodule, it has grown significantly compared to last year's imaging.
Furthermore, the location of the nodule is densely covered with blood vessels. If it develops to the 'micro-invasion' stage, it is very likely that the cancer cells will be quickly transferred to other places through the capillaries, causing more serious consequences! "

"so!"

"Although open-chest surgery is required and the risks are high, after comprehensive consideration we still believe that surgery is necessary now!"

“The benefits outweigh the disadvantages.”

Surgery?
Secretary Bai's heart skipped a beat, then he took a deep breath and whispered:

"How sure are you?!"

"If it's surgery, there's at least a 95% chance of success."

"I mean, how sure are you that the last nodule is a malignant nodule?!"

After the words fell, the three people headed by Director Hao fell silent.

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't stand the hardship any more!"

"Moreover, the aerospace project that Mr. Zhang is in charge of is currently at its most critical stage. Surgery at this time will inevitably affect the progress!"

"Of course, if the operation is really necessary, we are willing to do it, even at the cost of delaying the project progress to ensure the safety of Mr. Zhang's life, but the premise is that we hope to be 100% sure!"

"Three of you, are you 100% sure?"

(End of this chapter)