A truck with the banner "Song'an Province rushing to assist Yunhe Epidemic" was lying across the highway. The car behind the car had been twisted into a twist shape under the huge impact force - and the instruments loaded in the car had already scattered into countless debris on the ground.

The driver was not seriously injured. He stood beside his car, jumping and making a phone call. He didn't care about the minor injuries on his body, but he jumped and cried at the phone, "Come on, hurry up, the car is equipped with things that Yunhe can save his life!"

The news that the logistics vehicle overturned due to a tire blowout on the way quickly reached Song Wen's ears. Her first reaction was to quickly ask the driver's condition, "Are you okay?"

"There are no problems." Director Han Wenping, who had just discharged kidney stones, said calmly, "There were several minor abrasions, but there were no important injuries. After the preliminary treatment, the person has been arranged to be quarantined locally."

"Just be fine if you're okay." Song Wen breathed a sigh of relief. She changed into a relaxed face and smiled at Director Han Wenping with a gloomy face, "Talent is the first priority. You can still raise more if you don't have anything."

Han Wenping sighed, "Masks and protective clothing are easy to deal with. Even if they can't raise them in Ningyuan for a while, Yunhe's medical team will come over if they ask for some support. The problem is... an instrument in the car was damaged, and I can't raise this thing in a short time."

Yes, the car is equipped with the only artificial liver support system in the Fourth Hospital. This precision instrument was smashed into a "factory setting" in this car accident - the parts were paved with two lanes, and if you want to fight back... you may need to replace all the parts.

This set of equipment in the Fourth Hospital is different from the general artificial liver support system. It is currently a relatively high-end hybrid artificial liver support system. In addition to the semipermeable membrane like traditional artificial liver, this set of equipment is equipped with hollow fiber tubes of pig liver cells. Compared with the traditional physical artificial liver system, this set of hybrid artificial liver also has the detoxification function of physical artificial liver and the biochemical synthesis and transformation functions of biological artificial liver.

In addition to the three major disadvantages of equipment efficiency far less than that of the real liver, the expensive cost during use and the scarcity of the source of the bioreactor, the role of the hybrid artificial liver can play is almost no different from that of the real liver.

Xiao Yanran was supported by this mixed artificial liver for more than half a year, and then waited for the first liver transplant.

Now... this artificial liver support system, which has made great achievements in the Department of Hepatobiliary Surgery in the Fourth Hospital, has completely become a waste product. The only thing that is thankful is that the pig liver cell hollow fiber tube packaged with it was not damaged because it was packed in a special anti-impact suitcase.

"All equipment transported is insured, and we have no losses." Director Han Wenping said helplessly, "The problem is that having fiber tubes alone is useless. No matter how much consumables are available without equipment, it is useless."

"Have you contacted the manufacturer?" Song Wen asked frowned, "It's already the 28th, they should have resumed work, right?"

The hybrid artificial liver support system purchased by the Fourth Hospital is a domestic model. Compared with imported products, the biggest advantage of the domestic model is that it is more convenient to produce and after-sales service. Although consumables are still difficult to buy, they are always more convenient than importing from abroad.

"I've contacted them before I came." Han Wenping's expression looked a little better, but his brows were still tightly frowning. "The other parts are all in one. The only problem is that the two models of motors used in the equipment are imported products, and this... is not in stock."

"Let them find a way." Song Wen's expression did not change at all. She said very directly, "It's a special period. I don't care what method they use, at least I have to make one of the equipment immediately for us to use it first - this is something to save lives!"

Before coming, Han Wenping had already communicated with artificial liver manufacturing companies. "They have a suggestion, I think they can consider it. They are planning to replace it with domestic motors, but the domestic versions of these two models of motors have not undergone shaping experiments before. In order to prevent problems during use... they will send two artificial liver systems equipped with domestic motors at a time. In this way, if something goes wrong, we have a second one to support it first."

"I don't think it's a problem." Song Wen nodded, then asked, "What if there is a problem with the second one?"

"The motor manufacturers and artificial liver will send an engineer to the station. If there is a problem with the equipment, they will wear protective clothing and go directly to the red zone for repair." Han Wenping said, "In short, try to ensure that the equipment here can operate normally."

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When Sun Lien heard that the artificial liver that he was eagerly looking forward to was actually dissipated into parts on the road, his heart suddenly became cold.

"Can you deliver two spare units this afternoon?" I felt cold, and another good news was delivered to Sun Lien, "That's great!"

Han Wenping explained the ins and outs of the two devices to Sun Lien on the phone and said seriously, "To put it bluntly, you can only have one device on hand to use. Moreover, since the motor used by this device is different from before, it is very likely that one or another will occur during use."

"If you have it, it's better than not." Sun Lien said seriously, "I'll arrange the medicine now. Have the consumables been delivered?"

"Consumables can be sent to the hospital at noon." Han Wenping replied, "I will notify you immediately after the equipment arrives."

After putting down the phone, Sun Lien stood up excitedly and walked around for two rounds. Although the equipment was several days later than expected to be delivered and was damaged on the road, he still had something to use in his hand in the end, which was a good thing.

"Lien, are you going to the seminar later?" Sun Lien happily circled around the restaurant. Zhou Jun suddenly found Sun Lien who was in the restaurant. He came over with a plate and asked, "I heard that the main discussion of this seminar was the autopsy report of the dead patients with pneumonia caused by the novel coronavirus."

"Go." Sun Lien nodded and said, "I'll definitely go and listen to this kind of thing quickly - I really don't know much about pathology... I just take this opportunity to see the experts' clinical judgment of confirmed patients."

Zhou Jun put the plate on the table, "Then we'll go together. I wonder if this seminar can be finished before I go to duty. If it's too late, remember to record a video of me on your phone and I'll continue watching it when I come back."

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In the end, Zhou Jun still failed to catch up with the seminar. The departure time of the shuttle bus was fifteen minutes ahead of schedule, while Professor Liu's team, who arrived at the hotel from the previous venue, was thirty minutes late.

Sitting in the venue, Sun Lien looked at the anatomical pictures and pathological section reports displayed by the projector in a complicated mood.

"According to our direct observation, organ edema caused by the novel coronavirus is more serious than organ edema caused by other viruses. For this mechanism, our preliminary research believes that ACE2 on vascular endothelial cells mediates secondary infection of the bronchial debrogen and damage to the vascular endothelial cell." Professor Liu, who reported on the podium, was hoarse, and a series of states such as "vocal cord congestion" and "fatigue" were hanging brightly on the status bar. But he still insisted and repeated the content that he had already talked about three times today. "In addition to increasing the viral load in the lungs, such damage will also recognize and attack endothelial cells with high expression of ACE2 with viral tuberculosis. We believe that this is probably one of the reasons why a large number of severe patients with novel coronavirus have inflammatory storms at the same time."

"This is the subsequent autopsy picture. I will briefly give you some details." Professor Liu quickly pressed a few ppts and said, "This specimen is the first lung of a patient who died of pneumonia caused by the novel coronavirus. This specimen has very obvious inflammatory lesions, and the lungs look patchy from the naked eye. You can see on the section that a large amount of viscous secretions overflow from the alveoli and there are fiber cords."

"The characteristics of this specimen suggest that the novel coronavirus mainly causes inflammatory reactions characterized by deep airway and alveolar damage. This is consistent with our clinical experience. At the same time, according to a previous report on fine needle aspiration of lung tissue in a group of confirmed patients, the pathological characteristics of pneumonia caused by the novel coronavirus were very similar." Professor Liu coughed twice and then said, "But our anatomical observations found that the patient's lung fibrosis and consolidation were not as serious as those caused by sars, but the extension reaction was more obvious than that of sars."

"At present, most of the confirmed patients who have died within fifteen days of the disease." Professor Liu quickly brought a bunch of other pathological examinations and emphasized the clinical work. "Because the novel coronavirus and sars are highly similar, I personally believe that the possibility of lung fibrosis caused by the novel coronavirus cannot be ruled out. It can only be said that the patient's disease course is within fifteen days, and the risk of lung fibrosis is lower than that of sars."

"If you find patients with lung fibrosis in clinical work, please pack the patient's disease course and case upload system after confirming the occurrence of lung fibrosis. We will have further analysis." Professor Liu said before closing his speech, "The novel coronavirus is still a new and unfamiliar disease. The more we study it, the more likely it is to find a way to deal with it and treat it."

Professor Liu's speech ended, but where could the doctors in the audience missed this opportunity? Everyone started to raise their hands to ask for a question. Seeing everyone's positive appearance, Sun Lien suddenly realized why Professor Liu's team was half an hour late before - probably he was surrounded by the doctors who were actively asking questions and couldn't get out?

Sun Lien himself also had questions to ask. After Professor Liu had answered three or four questions, he waited for the microphone and asked, "Professor Liu, does the large amount of alveolar mucus found in the dissection mean that the effect of oxygen therapy alone for patients may not be good. We should consider more actively using mucus dissolving drugs such as ambroxol, and then expel sputum and bronchial suction?"

"This is definitely more in line with the conclusions we have reached in general anatomy." Professor Liu nodded and said, "Although the patient has alveolar damage, the degree of alveolar damage is not particularly severe under the microscope. To explain the severe stubborn hypoxemia of the confirmed patient, you can only start with mucus blockage."

"The ace2 receptor is present in a large number of people, and it also has a large number of manifestations in the intestinal epithelial tissue." Sun Lien continued to ask, "Does there be any lesions in the general intestine during this dissection?"

"The small intestine is interspersed with segmental dilation and stenosis." Professor Liu nodded, "but there was no serious injury to the tissue under the microscope. It is not yet certain whether this lesion is related to infection or to the patient's individual lesions. The subsequent several cases of dissected generally did not show gastrointestinal symptoms during their lifetime, and their small intestines looked normal."

"Among the patients we treated, several cases reported olfactory changes." Sun Lien continued to ask, "Did the patients show central nervous system during the general anatomy you performed?"

Professor Liu turned off the ppt and opened a folder. After searching for the pictures inside, he opened a picture and said, "From the general appearance of the brain, you can see symptoms of cerebral edema and mild atrophy of the cerebral cortex. However, based on clinical data, I think that this general nervous system change should have nothing to do with infection or is not closely related to infection."

Professor Liu also opened a case report that erased the patient's name and explained, "The patient is old and has sequelae of multiple cerebral infarction and cerebrovascular disease. At least from the naked eye, I did not find specific manifestations of the infection. As for the abnormal olfactory you mentioned, whether this means that the virus invades the nervous central system remains to be verified by histopathology."

Sun Lien's question has been asked. To be honest, these questions have not been answered very well.

He also understood the alveolar mucus in his previous clinical work. After all, they had washed out the branches under the bronchoscopy, mixed with blood sputum. After severe patients were ventilated in prone position, hypoxemia often improved. Based on these two points alone, doctors could roughly infer that there was a large amount of mucus in the alveoli in the patient's body.

The more noteworthy intestinal lesions and central nervous system were not directly confirmed in this general anatomy, which made Sun Lien a little helpless.

Not directly confirmed means that there are still two different explanations for other organ damage in patients - virus damage or immune system response damage. Although both are organ damage, the treatment methods taken by the two different mechanisms are completely different.

If it is viral damage, it means that there is a high probability that there will be live viruses floating in the patient's blood. For such patients, active plasma replacement may have a certain effect. If it is immune damage, an immunosuppression regimen should be considered for control.

The content of central nervous system disease is more important - nerve damage is often irreversible. If olfactory abnormalities are determined to be related to central nervous system damage, it means that the treatment threshold for patients should be more actively and in advance. If necessary and have resources, it should even be considered to use recovered plasma for ordinary patients to avoid possible nerve damage.

Thinking of this, Sun Lien couldn't help but sigh. It would be great if the recovered person on hand had too much plasma to be completely useless. If there were enough personnel, just follow up and investigate the recovered and discharged patients...

If recovered people have too much plasma to use, they can naturally consider using it earlier to neutralize the virus and reduce damage. If enough people follow up on recovered patients, they may also find other sequelae of novel coronavirus infection related to central nervous system disease.

The questions from other doctors ended about twenty minutes later. Professor Liu stood up swayingly and began to pack up and prepare to leave. Sun Lien walked to the stage and handed the amazing old man a can of black coffee.

"You need a good rest." Sun Lien frowned as he watched Professor Liu take the coffee and drink it all. "Now Yunhe's condition has improved significantly. We have accumulated a lot of experience in clinical practice, and the demand for autopsy reports is not so urgent."

On the 28th, Yunhe added a total of 420 confirmed patients, and the number of discharged patients reached 1,726. As the nucleic acid testing capacity further increased, on the 28th alone, Yunhe conducted a total of more than 20,000 nucleic acid testing.

You should know that from 18:00 on the 27th to 18:00 on the 28th, Yunhe's city-wide fever clinic has received a total of 2,626 people. Yunhe's current nucleic acid testing capabilities can fully cover all patients in the fever clinic, and it is no longer difficult to perform nucleic acid examinations on all patients with fever.

"You have experience, but experience is not omnipotent." Professor Liu smiled and shook his head, "We are scientific and technological workers who work under scientific guidance. We must have something real to bring out to turn your experience into a practical solution."
Chapter completed!