(500 words are missing, don't read it first, wait for me to change it)

Seattle, USA at 4:30 am. (8:30 pm Tokyo time)

Because he stayed up late for many years and got older, Coent had a poor sleep quality and he didn't fall asleep until one o'clock in the morning today. In order to ensure that he could have a good working condition after waking up, his wife had moved to the empty room next door alone a few years ago, for fear that he would turn over and wake him up.

Even so, Coent today can only rely on the help of sleeping drugs to fall asleep.

From one slept until seven the next morning, the full six-hour sleep is his red line. If it is less than this length, if you lack sleep or are awakened the night before, you will definitely yawn the next morning.

It is logical that his state needs absolute silence. His phone must be turned off normally, and even a trace of light cannot be there.

However, there were two serious patients in the emergency room today. In order to understand the patient's condition as soon as possible, Coent insisted on turning on the ringtone of his cell phone. It was a coincidence that he had been waiting for a night but didn't come. As a result, Coent had just snored for a while and was woken up by a burst of rapid phone ringing.

After hearing the phone ring, he sat up like a conditioned reflex, and after he was surrounded, he found that there was no ventilator or other colleagues around him. Only then did he realize that he was not on duty, but at home.

After confirming his location, Coent took a breath twice and picked up the cell phone beside the bed.

The number of an old acquaintance is displayed on the screen.

Coent squinted his eyes and looked at it for a long time, his mind was in a mess. After thinking for a while, he still answered the phone: "Why are you calling me at this time? It's not dawn yet, it's only 4 o'clock."

"Oh? Is it? I don't count the time." The person who called was a little sorry, "I'm really embarrassed. I'm more anxious about this matter. I want to ask Teacher Coent a question."

“What’s the problem?”

Coent knew that Qi Jing's ability and something that could confuse him was definitely not simple. This stimulation made the old man feel energetic. He woke up half of his sleepiness, but now he is only three or four minutes left.

"If the emergency department receives a patient and finds that she has mild muscle pain, constipation, a slight enlargement of the heart, and has premature ventricular attacks, what is the first thing the teacher thinks about?"

"Why does this symptom sound like an emergency patient?" Although the old man has not yet woken up, his thoughts are clear. "Does the heart enlargement, ventricular premature beats have heart-related symptoms?"

"No."

"Why are you sending me here if it's not an emergency department?"

"I'm just giving an example... Then I'll change one. There is a patient in the ward who has the symptoms just now. What is the teacher's first consideration?"

"Muscle pain, constipation, and enlargement of the heart. I think this disease is attacking muscles." Coent is a world-renowned emergency doctor in internal medicine. When he heard these symptoms, he immediately had a concept in his mind, "There are three types of muscles, skeletal muscles, gastrointestinal smooth muscles and myocardium."

"Well, the teacher is really sharp."

Coent rubbed his forehead, then pressed his sleepiness for two or three minutes, and said, "What's so sharp? I can see these. The specific cause needs to be checked slowly."

There are many muscle-related diseases, and Qi Jing was also trapped in the trap of differential diagnosis at the beginning. Now seeing Coent like this, he explained his entire idea:

"At first, I didn't know I had a heart problem, so I suspected it was tuberculosis. Later, I found that there was no tuberculosis infection, so I thought it was myopathy, but the result was normal for both autoimmune antibodies and other tests. After the myopathy was eliminated, I began to suspect myocarditis again, but the patient's symptoms were very mild, the frequency of premature ventricular frequency was not high, and the heart-to-thoracic ratio was just a little larger. The key was that she had no symptoms yet..."

"So you eliminated myocarditis," Coenter said the next words for him when he saw him talking nonsense, "Is it possible that it is drug-derived myocarditis?"

"I've asked, I haven't taken this type of medicine, and her suitcase is also clean." Qi Jing continued, "I even suspected cadmium poisoning."

"Yes, cadmium poisoning can affect calcium ions, and it has an impact on muscle contraction, bone growth and heart." Qi Jing once again refreshed Coent's upper limit for commenting on him, "You can think of this."

"It's a pity that I looked up the key points of heavy metal poisoning and thought twice, and found that it shouldn't be cadmium poisoning."

"Have you checked the heavy metal?"

"She is not a chemical factory worker and can't get in touch with this kind of thing. And her kidneys are fine, so it should be good."

After Qi Jing finished speaking this round, Coent was completely awake.

He lifted the blanket and got out of bed, put on a glove, left the bedroom and went to the study.

Although these symptoms sound fine, one connection is muscle. The muscle diseases that can be thought of now are not reliable, which means it is a rare disease that you can't see normally. Coent first thought of the family of three he had treated before: "I took this patient a few years ago, and the same symptom."

"Oh?" Qi Jing was a little happy after hearing this, "Did he come from South America?"

This question made both parties exchange it, and it was Coent's turn to be happy: "How do you know it is South America? The patient in your hand is South American?"

"That's not, it's just a Chinese from Mi."

"Chinese?" Coent thought for a while, but it didn't matter, "then you should have been to South America."

"I haven't asked her yet, but judging from the existing clues, I should have been there." Qi Jing said, "If we subdivided it into the country, I guess it should be Argentina."

"Argentina......"

Cowan nodded, knowing that Argentina is also the hardest hit area of ​​the disease: "It is really terrible. Zhengfu has also made relevant documentaries specifically for locals, and the scene seems to be in Argentina. It seems that it has been on guard in recent years, and I hope it can persist."

"I have heard of that documentary. Because we have never found this disease in our country, few people know about it." Qi Jing was indeed bored, but he didn't have a deep impression of this disease.

Speaking of this disease, Coent didn't know how to describe that feeling. After thinking for a long time, he ended up "despair": "The prognosis of this disease is very poor. Are you sure that she has these symptoms? Is it possible that there is something else?"

"I'm 80% sure."

In fact, Qi Jing does not have laboratory methods to detect this disease, so everything can only be judged by speculation.

The reason why I can be so confident now is that after eliminating the differential diagnosis, this is the only one left: "I really have nothing to doubt. In the end, Argentina can only be thought of by the patient's hand-dressing beads."

"Beared string?"

"Well, red stone, the national stone of Argentina, also known as the Inca rose."

"Since you have the answer, why do you want me?" Coent yawned several times in a row: "I'm so sleepy, I have to go to bed as soon as possible. I can't sleep if I'm late."

Qi Jing had to apologize repeatedly: "I really want to hear Teacher Coent's opinion. I'm so anxious, sorry."

"Then let's do it first, bye."

Coent wanted to hang up the phone after saying that, but Qi Jing apologized, but he didn't mean to hang up: "Wait, Teacher Coent, I want to ask how to treat it if it's really that disease?"

"To say treatment..."

After all, Coent is just an emergency doctor and must have seen this infectious disease, but if you want to treat it systematically, you still have a breath of pain: "I don't know much about this. I remember that there is no special medicine for Chagas disease, so it can only be treated symptomatically. By the way, if it is in the acute stage, I remember that I can use benzone, and the effect is pretty good."

"She is obviously chronic."

"Chronicity can only be dragged."

"Is there no other way?"

"this......"

Coent was questioned by Qi Jing and thought for a long time before saying, "If you really want to learn about this disease well, I really know an old friend. By the way, do you know niaid?"

niaid, the National Institute of Allergy and Infectious Diseases in the United States.

Of course Qi Jing knew about this place. Before he was reborn, he applied to study there. It took three months to open the email. After all, it was a state institution and involved some secrets from the United States, so he was ruthlessly rejected at that time.

Later, due to work, he also had some contact with several researchers there, but he was not familiar with each other.

Originally, niaid was the springboard for Qi Jing to achieve his goals, and thought he should go to the United States to get in touch with him from 2008 to 2009.

But now Ye Han's situation suddenly emerged. It is better to choose a day than a day. He wanted to use Coent to get some contact with him for the time being. As long as he got in touch, he had a way to slowly move up.

At this time, Qi Jing tried his best to show nature. Institutions like this, ordinary domestic people didn’t know its abbreviation at all. Even if he specialized in infectious diseases, he didn’t know such a place until 2009.

So Qi Jing didn't say hell: "It should be a research on infectious diseases."

"Well." Coent said directly, "It's the National Institute of Allergy and Infectious Diseases. I know a deputy director there who specializes in studying parasites."

"Oh?" Qi Jing seemed excited, "Do you have a phone call?"

"Yes, there are, but..." Coent wanted to say something but stopped, "He has no good feelings for you Chinese people, you know the more noble ones."

"Oh, that's right." Qi Jing thought about it, but still thought he would seize this opportunity first, "Why don't you talk to him about this disease after the teacher meets him?"

"This is no problem." Coent agreed immediately. As for the phone number he didn't give, he was afraid that Qi Jing would call him directly as if he was calling him. With the other party's temper, even if he added the American nationality, he would not give him any good face. A young doctor from China called him to harass him before dawn in the early morning. At that time, it would be more than just disgust.

Although the two have a good relationship, if they really make taboos, they might even be criticized together.

"You wait for my phone call."

"good."

......

Time changed to 9:00 am the next day. (Seattle time, 17:00 pm)

Ye Han finally ushered in his heart color ultrasound examination. This time the examination was different from ordinary patients. Not only was the bed doctor Yamada followed, but even Miyao, who seemed indifferent before, followed. In addition, Qi Jing, who was particularly interested in Ye Han's heart, had a lot of people in the color ultrasound room for a while.

"Director Miyano, come on, sit down." The two doctors in the ultrasound room looked at Yamada and Miyano behind them with a little restrained attitude.

"Why do you want to sit for me? I don't know how to do color ultrasound." Miyao's mind was thinking about Ye Han's heart, so he wanted to finish the examination and get a normal result sheet, and then let someone get out as soon as possible. "Why do I do it quickly, I'm in a hurry."

"Is this patient that serious?" The doctor in the ultrasound room looked at Ye Han who was standing beside him and frowned.

"What are you waiting for?"

"Oh, I got it."

Color ultrasound actually has an extra direction of blood flow, and other places are no different from the original B-ultrasound. However, after applying gel, the probe was put on Ye Han's chest, and the few people in front of the screen immediately saw some strange places.

Some electrocardiograms that were originally recorded and transmitted into plane electrical signals have now become two-dimensional images, which immediately became much clearer.

After the heart color is superimposed into a graph, you will immediately see four areas of the heart, left and right atrium and left and right ventricles. The atrium is drawn and the ventricles are pumped, but a small gap appears at the distal apical position of Ye Han's left ventricle.

Although Yamada Miyao is greedy for money, this place is Shirahara Memorial Hospital and Asia's leading cardiac treatment center.

They saw the gap at a glance and soon thought that there was a problem with this part of the myocardium.

"I just said there is a heart problem." Qi Jing saw such a heart color ultrasound image and basically clarified his previous guesses.

The color ultrasound requires measurement of the various values ​​of the heart, the thickness of the heart, the inner diameter of the heart cavity during systolic and diastolic, valve closure and blood flow, pulmonary artery pressure,

Color ultrasound actually has an extra direction of blood flow, and other places are no different from the original B-ultrasound. However, after applying gel, the probe was put on Ye Han's chest, and the few people in front of the screen immediately saw some strange places.

Some electrocardiograms that were originally recorded and transmitted into plane electrical signals have now become two-dimensional images, which immediately became much clearer.

After the heart color is superimposed into a graph, you will immediately see four areas of the heart, left and right atrium and left and right ventricles. The atrium is drawn and the ventricles are pumped, but a small gap appears at the distal apical position of Ye Han's left ventricle.

Although Yamada Miyao is greedy for money, this place is Shirahara Memorial Hospital and Asia's leading cardiac treatment center.

They saw the gap at a glance and soon thought that there was a problem with this part of the myocardium.

"I just said there is a heart problem." Qi Jing saw such a heart color ultrasound image and basically clarified his previous guesses.

The color ultrasound requires measurement of the various values ​​of the heart, the thickness of the heart, the inner diameter of the heart cavity during systolic and diastolic, valve closure and blood flow, pulmonary artery pressure,

"I just said there is a heart problem." Qi Jing saw such a heart color ultrasound image and basically clarified his previous guesses.
Chapter completed!