The genetic testing of Sanbo Hospital is generally sent to the genetics laboratory of Nandu Medical University, which is a state key laboratory, and the director Lin Lan is Su Nanchen's fiancée.

Soon, the genetic test results of Linköping have come out, Linköping belongs to SCA3 type, and this model of hereditary cerebellar spinal ataxia is the most common in China.

Spinocerebellar ataxia, abbreviated as SCA, if strictly defined, should be a group of neurological genetic diseases caused by genetic mutations leading to degeneration of the cerebellum, brainstem, and spinal cord, with progressive motor coordination function and balance disorders as the main clinical manifestations.

At first, doctors thought that the way of inheritance of the disease was autosomal dominant inheritance, but with the deepening of the study of this disease, it was found that its inheritance mode is not limited to autosomal dominant inheritance, but also has a variety of inheritance methods: autosomal recessive inheritance, X-linked inheritance, and mitochondrial inheritance.

So far, researchers have found a total of 33 kinds of hereditary cerebellar ataxia, most of which are caused by abnormal repeated amplification of trinucleotide copy number in the exon of the corresponding gene to produce polyglutamine. The pathological changes are neuronal cell detachment and glial hyperplasia, and the mutant protein containing polyglutamine is deposited in the nucleus to form intranuclear inclusion bodies, although the basal ganglia, optic nerve, peripheral nerves, etc. can also be involved, but the lesion sites are mainly in the spinal cord, brainstem, and cerebellum.

Li Guodong consulted a large amount of information and compiled a table that listed the various genotypes, the corresponding symptoms of each type, and the literature summary of various treatments.

Not only that, Li Guodong also wrote a detailed review of the disease, making a retrospective summary of the previous literature.

Even for a large number of failed drugs and methods, Li Guodong also did some combing and sorted them out in his review.

He handed over the review to Yang Ping, who was very satisfied after reading it, this kind of scientific thinking is very important for future work, as a doctor, you need a rigorous work attitude.

When everyone had free time, they gathered again to discuss Linköping's surgical plan.

"Professor Yang, I've been thinking about why we don't just use arterial bypass technology, I analyzed these MRI films for a long time last night, and the vascular diffusion images in them show that the blood supply in these places is indeed obviously insufficient, why don't we use arterial bypass grafting technology to improve blood circulation here like the heart, no matter what the cause, I think it should be effective."

Li Guodong is very inquisitive, and he has really been studying these MRI images.

His question resonated with everyone, and Song Zimo and Xu Zhiliang were also thinking about it. If vascular bundle grafting increases cerebellar damage, vascular bypass grafting does not, and can be performed on the surface of the cerebellum or in the original vascular walking space.

"Yes, I'm also thinking about this question, Li Guodong has a good question." Song Zimo responded.

Xu Zhiliang also followed: "I-I was also thinking about -—— asking." ”

"It seems that everyone has thought of a piece, and I am now thinking about whether to use cerebellar artery bypass surgery, but to perform cerebellar artery bypass, we doctors will have a lot more work to do, and the risk will also increase a lot, we need to study the cerebellar blood vessels, study all the previous results on the anatomy of cerebellar blood vessels, determine the precise division of cerebellar blood vessels, what exactly are these ischemic areas that you just talked about, we need to figure out, and then we can plan how we can bypass the bridging."

Yang Ping happened to be studying this issue, and by the way, I would like to talk to you in detail, it seems that everyone is indeed very attentive.

"Remember who was the first doctor to perform coronary artery bypass surgery?" Yang Ping asked everyone.

"Doctor Favaloro of Argentina!"

Song Zimo, Xu Zhiliang and Li Guodong answered at the same time.

Their memories of these are very clear, and only people who are very interested in medicine will pay attention to the history of medicine, otherwise what anatomy, physiology, pathology, biochemistry, etc., have already made people dizzy, how can they still have the energy to read the history of medicine.

When Dr. Favaloro was studying at Cleveland Clinic in the United States, his roommate Sones was the father of angiography, and Sones happened to develop cardiac coronary angiography technology at that time, Dr. Favaloro has always liked cardiac surgery, so he was particularly fascinated by coronary angiography pictures, and every day as long as Sones completed coronary angiography and new pictures came out, Dr. Favaloro would spend hours studying these coronary angiography pictures. Studying the relationship between blood vessels and heart muscle, influenced by his friend Sones' research on angiography, Favaloro was convinced that coronary artery bypass grafting could treat coronary artery stenosis or blockages. ”

"Dr. Li Min, do you know what Dr. Favaloro did before applying to Cleveland for further study?" Yang Ping suddenly asked Li Min, who was listening attentively.

Li Min didn't know the story, so he shook his head.

"Dr. Favaloro, who has been working as a country doctor in Argentina and is a general practitioner, applied for further education at the Cleveland Clinic in the United States at the age of 40 and was approved by Cleveland, and at the age of 45, he performed the world's first coronary artery bypass surgery in Cleveland." Yang Ping briefly introduced this legendary figure.

What an inspirational story, Li Ming became interested in Dr. Favaloro's story.

Yang continued, "Dr. Favaloro's first coronary artery bypass surgery patient recovered very well, so some new surgeons can still have great results as long as they are well researched in theory, even if they have not been clinically tested, and the fontan surgery in cardiac surgery is the same, and the first case is also effective. ”

Yang Ping's initial surgical plan was to use a muscle flap transplant with vascular pedicle, which was more secure, and the postoperative surgical effect would be slower.

This may be a good thing for the doctor, as it is safe to say that the risk of the procedure is lower, but for the patient, immediate results can build strong confidence.

In order to build Ranköping's confidence, Yang Ping decided to change the surgical method, and the way of decompression remained the same, but the way to improve blood circulation was to use a faster and more direct arterial bypass.

''Even if there are monographs and papers in neurosurgery, the study of blood supply to the cerebellum should not be as accurate as the blood supply to the heart, right?'' Song Zimo asked.

Yang Ping nodded: "This is one of our difficulties, we must be like Dr. Favaloro studies the relationship between the coronary artery and the myocardium, we have to re-study the arterial blood supply vessels of the cerebellum, because all the previous related studies have never been intended to be used to guide cerebellar arterial bypass, so naturally it will not be as deep as cardiac research." ”