Chapter 54 Jiang Xiaoyu of Villain's Valley

Director Chi, the patient's scans are extremely typical; it should undoubtedly be advanced cancer, Gu Huaiming apologized. It's possible the depth of the puncture biopsy wasn't sufficient. I'll go back and check, and perform one myself.

Alright, if you get a new specimen, call me directly.

Director Gu returned to the ward with the pictures of the specimen under the microscope. He pondered for a long time, but ultimately did not contact Dr. Zou.

What the families of patients fear most is not that the patient is terminally ill, but rather being given hope one moment only to be plunged into despair the next.

With their emotions riding a roller coaster, even the sanest person would be wracked to pieces.

Many patient families are driven mad by this cycle of despair and hope, sparking numerous medical disputes.

Although Dr. Zou was one of their own, and he wasn't overly concerned with medical disputes, Gu Huaiming still prudently refrained from giving her an uncertain answer.

Hesitating for a moment, Gu Huaiming picked up his phone and called Luo Hao.

Dr. Luo, it's me, Gu Huaiming.

Director Gu, are the pathology results out? Is it inflammatory? Luo Hao asked directly.

Gu Huaiming truly had no idea where Luo Hao's unfathomable confidence came from.

However, fine, Luo Hao had guessed correctly this time.

You guessed right, Dr. Luo. Director Chi did not find any tumor cells under the microscope.

Holding his phone, Luo Hao smiled faintly as the diagnostic panel in front of his eyes updated.

Although it was still a preliminary diagnosis and the content remained a pulmonary space-occupying lesion, the differential diagnosis had changed.

Previously, Penicillium marneffei infection held the top spot in the differential diagnosis, but with the refinement of the examination results, adult immunodeficiency syndrome mediated by anti-interferon-gamma autoantibodies had been elevated to first place.

Luo Hao grew even more confident.

The system was truly useful. It was well worth angering all those elders and insisting on returning to the Mining General Hospital, only for the treasure to unlock after two more years.

Regardless of the future, judging solely by this advanced lung cancer case, the system's diagnostic assistance AI was simply too intelligent.

Director Gu, are the test results for fungal (1,3)-beta-D-glucan out? Is it strongly positive? Luo Hao asked.

Gu Huaiming opened his computer workstation and pulled up the lab test sheet of Dr. Zou's grandfather.

Just as Luo Hao had "guessed," the fungal (1,3)-beta-D-glucan test result was strongly positive.

Strongly positive, correct.

I believe this is not a malignant tumor, but rather an inflammatory change. As for what disease caused the inflammatory change, we need to investigate further, Luo Hao's voice came through, causing Gu Huaiming's brows to furrow.

How could Dr. Luo Hao be so arbitrary?

Who on earth gave him the courage to directly conclude it wasn't a malignant tumor!

Naturally, Gu Huaiming didn't want the patient to have a malignant tumor either, but a doctor must remain objective and neutral.

It must be that little troublemaker Luo Hao desperately wished Dr. Zou's grandfather would be fine, Gu Huaiming thought to himself.

Dr. Luo, since it's not a malignant tumor, what disease do you think it is?

At this point, Luo Hao fell silent.

Gu Huaiming shook his head. Luo Hao was just as he had guessed; he didn't have a clue in his heart.

Director Gu. Luo Hao's voice interrupted Gu Huaiming's thoughts.

Go ahead, Dr. Luo.

Last night I took the patient's medical history, and the patient has a history of eating bamboo rats. I suspect a Penicillium marneffei infection, Luo Hao said. But today I have a new perspective.

Penicillium marneffei infection? Director Gu immediately perked up. He completely ignored Luo Hao's last sentence and focused entirely on the Penicillium marneffei infection caused by eating bamboo rats.

He had encountered a few patients with Penicillium marneffei infections. Looking at their symptoms and scans, they indeed all presented like advanced cancer.

Combined with the patient's history of eating bamboo rats, the strongly positive fungal (1,3)-beta-D-glucan result, and the absence of cancer cells in the pathological examination, a flash of lightning crossed Director Gu's mind in an instant.

The previous haze dissipated, revealing a clear sky.

In his heart, Gu Huaiming began to lean toward the diagnosis of Penicillium marneffei infection being correct.

Unawares, the corners of Director Gu's mouth lifted.

Director Gu, let me contact the Peking Union Medical College gene laboratory to run a test.

No need. Upon hearing the mention of Peking Union, Gu Huaiming felt a slight aversion.

Was the former South Building of 912 inferior to the marshal's mansion? Or is the West Ward of 912 currently inferior to Peking Union?

That bastard Luo Hao, an ungrateful little wolf cub, was born with the Peking Union mindset of looking down on all doctors in the world.

Gu...

I'll conduct a comprehensive examination here first, and then we can talk, Gu Huaiming said decisively.

Alright. Luo Hao didn't press the issue and agreed, following Gu Huaiming's lead. Director Gu, if there are any results, be sure to let me know.

Rest assured, I'll tell you the very first moment I know.

After hanging up the phone, Gu Huaiming didn't even dare mention Luo Hao's suggestion to his boss.

If the boss heard about it, it would inevitably lead to another bout of displeasure.

The possibility of the old man having a Penicillium marneffei infection was very high. Director Gu immediately began gathering experts from respiratory medicine, rheumatology and immunology, infectious diseases, and other departments to the West Building for a grand hospital-wide consultation.

With all the data laid out before them, the opinions given by the top experts after the consultation coincided precisely with Gu Huaiming's thoughts.

Penicillium marneffei infection!

Then they would continue with the tests to confirm the diagnosis.

Honestly, Gu Huaiming grumbled, eating bamboo rats—didn't he know it easily causes illness?

He clearly remembered a patient he treated when he was young, whose scans looked like advanced cancer, accompanied by progressive wasting, making him frighteningly thin.

Surgery was impossible, leaving only chemotherapy.

Yet the chemotherapy was terribly ineffective, but the person stubbornly refused to die. Advanced cancer, super-advanced cancer, seemed to forever linger in a state of being terminal.

In desperation, the family finally brought the patient to 912 to take a look.

After undergoing numerous tests, the patient was diagnosed with a Penicillium marneffei infection, and their condition improved after symptomatic treatment.

Although this case had no special connection to cardiothoracic surgery, Gu Huaiming remembered the matter and would always ask whether a patient had a history of eating bamboo rats whenever he admitted one.

If it truly was a Penicillium marneffei infection and they had gone ahead with surgery, that would have been a massive disaster.

The examinations proceeded in depth.

At 30°C, Penicillium marneffei exhibits a hyphal morphology, while at 37°C, it presents as a yeast morphology.

Transitioning from the yeast form to the hyphal form is relatively easy, taking only 1 to 2 days to grow brush-like branches and produce red pigment.

Two days later, looking under the microscope in the laboratory, the specimen still showed no changes whatsoever.

Gu Huaiming then initiated a battery of tests—taking bone marrow smears, lung tissue biopsy specimens, skin exudate impression smears, intestinal mucosal biopsy tissue, omental biopsy tissue, and lymph node biopsy tissue, performing periodic acid-Schiff staining, Wright's staining, or methenamine silver staining for microscopic examination, as well as fungal cultures.

However, whether it was using the ELISA method to test peripheral blood for the Penicillium marneffei cell wall mannan protein MP1P antigen, or indirect immunofluorescence to test peripheral blood for Penicillium marneffei-specific antibodies;

Or utilizing dot-blot ELISA, latex agglutination tests, and lateral flow immunoisolation chromatography to test urine for TM antigens, the results were all negative!

Gu Huaiming was mentally and physically exhausted.

It took only two days to go from full of confidence to utter despair.

Over on Dr. Zou's side, good news poured in continuously; the aortic dissection patient had already been weaned off the ventilator and could be transferred out of the intensive care unit in another day.

Yet his own side's examinations were stalling with no progress.

Gu Huaiming once again pulled strings, inviting the directors and experts of the relevant departments to sit down and share their opinions.

Two days ago.

Everyone believed the likelihood of the patient having a Penicillium marneffei infection was very high, but now, faced with comprehensive test results that bordered on medical over-testing, the experts fell silent.

All test results ruled out a Penicillium marneffei infection, and they also ruled out a malignant tumor.

Then what was it?

The one-hour-and-forty-minute consultation dragged on without a conclusion.

Gu Huaiming was helpless.

He thought of Luo Hao and muttered quietly, Could it really be time to go to Peking Union?

Director Gu, what kind of talk is that? an expert said unhappily. With these tests, would they even have a diagnosis at Peking Union?

Sigh. Gu Huaiming shook his head. Then let's leave it at that for today. Thank you all for your hard work; I'll go have a word with Dr. Luo.

Right, I heard there was some minor trouble over at Dr. Luo's place a while ago. How did that turn out in the end? the director of the rheumatology and immunology department asked.

Gu Huaiming had already dialed Luo Hao's phone.

As the beeping sound rang out, Gu Huaiming answered in the interim, It's nothing, it's long passed. That kid Luo Hao is as sly as a fox; his paperwork was meticulously prepared, not a single...

Hello, Director Gu, Luo Hao's voice came through.

Knowing smiles appeared on the faces of several experts.

Dr. Luo, all the relevant tests for Penicillium marneffei infection have been done, and there are no positive indications. With no other choice, Gu Huaiming had to tell the truth.

Director Gu, I've looked at all the recent test results, and the patient might be a classic difficult and miscellaneous case, Luo Hao said. I have a few thoughts of my own, though they might not be fully rounded out.

Don't be modest, Junior Dr. Luo, go ahead, the director of the rheumatology and immunology department directly interrupted Luo Hao.

Hello, Teacher Zhu, you're here too, Luo Hao greeted.

Don't bother with the pleasantries yet, share your views, the rheumatology and immunology director urged.

Difficult and miscellaneous cases should first be considered as rheumatological and immunological diseases, but since you are here, Teacher Zhu, I won't consider those first.

We could try genetic testing. I suspect the patient might have interferon-gamma receptor deficiency.

Huh? What kind of deficiency? Director Gu and Director Zhu of rheumatology and immunology asked in unison.

Interferon-gamma receptor deficiency.

Someone had already taken out their phone to search for the related disease.

For ordinary people, diagnosing ailments by looking at things on their phone is just scaring themselves.

Whatever can be baited out by a search engine is simply black-hat traffic that paid for advertisements.

But proper doctors certainly wouldn't use search engines; they log into professional websites to search for relevant papers and other materials.

Director Gu, Teacher Zhu, I still think we should send the specimen to Peking Union's genetic testing laboratory, Luo Hao said. I've already cleared things over there. Do you think this is feasible?

Director Gu furrowed his brow straight.

Are you certain? Director Zhu of rheumatology and immunology asked.

It had always been rheumatology and immunology doctors looking down on other specialists for not knowing how to treat patients; now, he was actually having Luo Hao teach him how to be a doctor, something Director Zhu found hard to accept.

I should be certain, Luo Hao said. Generally, interferon-gamma receptor deficiency develops in infants and AIDS patients, but patients with genetic defects also occasionally manifest the disease.

The complexity of this disease lies in the lack of indicators, and clinical testing cannot determine it either; one can only rely on a hunch and perform genetic testing to confirm the diagnosis.

While speaking, Luo Hao looked at the definitive diagnosis provided by the system's diagnostic assistance AI—interferon-gamma receptor deficiency.

Could there be any doubt about something certified by the system?

Certain of himself, Luo Hao explained in a steady tone, In laboratory tests, the patient's immune function is generally normal.

Further examination reveals that exogenous IFN-γ induces a decreased capacity in peripheral blood mononuclear cells from pediatric patients and clinically asymptomatic heterozygous individuals to produce TNF-alpha.

The experts from the relevant departments at 912 started with smiles on their faces, an indulgence toward the youngster, wanting to see what the legendary Jiang Xiaoyu from the Valley of Villains had turned into nowadays.

However, as Luo Hao's explanation grew more detailed, more certain, and more professional, the experts began to grow serious.

Thirteen minutes later, Luo Hao finished speaking.

To sum up, I believe the probability of diagnosing interferon-gamma receptor deficiency is very high.

The experts looked at each other in dismay.

During the previous preliminary diagnosis of Penicillium marneffei infection, none of them could manage an analytical diagnosis as logically clear as Luo Hao's.

After all, it was merely a preliminary diagnosis; no one would dare assert with certainty that it was a Penicillium marneffei infection.

Yet Luo Hao diagnosed interferon-gamma receptor deficiency with absolute confidence.

Fine, Dr. Luo. With no other alternative, Gu Huaiming responded, I'll send someone to retrieve the specimen and deliver it to Peking Union's gene lab. Leave me a message later telling me who to hand the specimen over to.

After hanging up the phone, Gu Huaiming fell into deep thought.

Dr. Luo hasn't let his basic skills lapse at all since returning home, someone remarked.

Yeah, strange. Not only has he not lapsed, but why do I feel like Dr. Luo has gotten even stronger than before?

Could it be that there are particularly many patients in his hometown?

Opinions varied.

All the experts knew Luo Hao and were quite interested in him.

This stemmed from a long, long time ago, when several heavyweights happened to take it into their heads in the same year to take on students.

Given their age, they should have long since dismissed the idea of taking students, and even if they held titles like doctoral supervisor, they would absolutely never teach someone hands-on; it was almost always handled by senior disciples.

Yet that year, a fortuitous coincidence occurred.

Some even speculated it was a chain reaction caused by a solar flare explosion.

Luo Hao had good luck; back then, his national college entrance examination score ranked first among medical students nationwide, attracting the attention of the heavyweights who had caught the bug.

Naturally, being at Peking Union Medical College, Peking Union's heavyweights took the lead.

The strange part was that the other heavyweights shouldn't have gone to Peking Union to poach talent, but that year, several heavyweights took a fancy to Luo Hao at first glance.

It was akin to love at first sight.

Thus, the name Dr. Luo was remembered by many in the circle.

Coupled with the fact that Luo Hao didn't stay at any hospital in the Imperial City after graduation, this made the urban legends even more colorful and bizarre.

Now, encountering a bizarre and rare disease, everyone listening to Dr. Luo's exposition shared a single thought—turns out there really is no such thing as ungrounded affection in this world.

Even if Luo Hao's reasoning for diagnosing interferon-gamma receptor deficiency wasn't entirely sufficient, just based on his clear-cut logical thinking and clinical analytical methods, everyone present felt a surge of appreciation.

Back then, the heavyweights fought over talent to no avail and ultimately had to compromise with one another.

Someone even self-deprecatingly joked that these heavyweights were like the villains of the Valley of Villains, determined to impart everything they had learned to Jiang Xiaoyu.

Luo Hao was that Jiang Xiaoyu.

Judging by now, Luo Hao had indeed inherited quite a few of their true skills.

Director Gu, let me know the moment the results come out, Director Zhu of rheumatology and immunology stood up and said, Be sure to tell me immediately.

Create a chat group, and announce it directly in there, someone had already started building a group.

Gu Huaiming sighed.

Were they really going to Peking Union?

Fine, if they had to go, they had to go.

Peking Union had invested considerable effort into the diagnosis and treatment of many rare diseases.

For instance, malignant hyperthermia, a rare anesthetic complication—Peking Union was the domestic institution that had researched it most thoroughly.

The antidote was also at Peking Union.

Interferon-gamma receptor deficiency? It wasn't that 912 couldn't diagnose it; they were just a bit slower, Gu Huaiming mentally made excuses for 912.

But if you wanted to get the results as fast as possible, you still had to go to Peking Union's gene laboratory.

...

Sister Zou, thank you, Luo Hao bowed slightly, expressing his gratitude.

It's what I should do, don't mention it, Dr. Zou said calmly. Dr. Luo, do you think my grandfather's diagnosis is correct?

Let's look at the results. I'm already rushing them, and we should know in about 12 hours. But no matter what rare disease it is, it's definitely not cancer, Luo Hao stated with certainty.

Dr. Zou let out a breath of relief.

Given the old man's advanced age, it wouldn't matter even if he had a genetic disease; they could just treat it symptomatically.

As long as it wasn't advanced cancer, the probability of the old man enjoying his remaining years and dying a natural death was extremely high.

I'll escort the patient to the general ward. Sister Zou, you should get some proper rest and not rush back, Luo Hao said. Trust me, wait for tomorrow's genetic testing results.

Alright, I'll go back to the hotel, take a shower, and get a good sleep. If I went home in this state, I'm afraid I'd faint. I wouldn't be able to help out and would just become dead weight, Dr. Zou self-deprecatingly joked.

Luo Hao escorted the patient back to the general ward.

For a cardiothoracic surgery patient to be transferred from the ICU back to the general ward three days post-op was practically a miracle for the Mining General Hospital.

This was attributable to Director Gu Huaiming's surgery and Dr. Zou's postoperative care.

Neither could do without the other.

With the patient transferred out of the ICU, this case could be considered concluded for the time being, and Luo Hao's attention shifted entirely to interferon-gamma receptor deficiency.

Interferon-gamma receptor deficiency was akin to Cthulhu—indescribable, impossible to diagnose through medical history alone, and reliant on sheer luck via the gene laboratory.

Consequently, diagnoses of this disease were few, and those capable of accurately diagnosing it were merely fortunate.

If the definitive diagnosis provided by the diagnostic assistance AI this time was correct...

At this thought, even Luo Hao's calm heart stirred with excitement.

That meant he possessed a formidable weapon!

An invincible, ever-victorious weapon!

Luo Hao urged his friends in the chat group to speed up and get the results out.

It didn't even take 12 hours. Ten hours later, the results came out: the diagnosis was definitive—interferon-gamma receptor deficiency!

The diagnostic assistance AI was truly a divine artifact!

Luo Hao was exceptionally gratified.

Picking up his phone, Luo Hao called Gu Huaiming.

Director Gu, the results just came out. Dr. Zou's grandfather has a definitive diagnosis of interferon-gamma receptor deficiency.

What? Gu Huaiming found it hard to believe.

It's interferon-gamma receptor deficiency. The margin of error for the genetic testing results should be very small; I've already urged them to run a duplicate test.

Uh... Gu Huaiming froze.

Luo Hao had actually come up with the correct diagnosis.

He didn't suspect Luo Hao of lying; no doctor would joke about such a matter.

The authenticity was beyond doubt.

Regarding treatment, I suggest transferring him to Peking Union. Peking Union has a research group specifically running projects for patients with interferon-gamma receptor deficiency. Do you think that's acceptable?

In his daze, Director Gu heard the polite form of address.

Luo Hao and he were quite familiar with each other, and he also treated him as the boss's closing disciple. With the senior disciple guiding the junior disciple, all his skills had been imparted without reservation.

Usually, Luo Hao addressed him informally; where had this formal address come from?

He wasn't that petty, and when it came to the diagnosis and treatment of certain rare diseases, Peking Union was indeed superior.

Forget it.

Director Gu helplessly shook his head. Fine, once the verification results come out on your end, I'll have the patient transferred over.

Director Gu, I'm escorting Dr. Zou back to the Imperial City today. The patient has already been transferred to the general ward. Thanks.

You're too polite.

The two exchanged a few flat remarks and hung up. Gu Huaiming proceeded to announce the results in the chat group that had been established just a few days prior.

Contrary to expectations, Gu Huaiming assumed the diagnosis of interferon-gamma receptor deficiency would trigger a huge shock and prompt everyone to discuss it actively.

Instead, the group was deathly quiet, as if no one had seen his message.

After waiting another dozen minutes or so, Gu Huaiming couldn't help but send a message.

[Did everyone see the results?]

[Saw them. I haven't researched this disease, so I wouldn't dare make a fool of myself.]

This remark came from Director Zhu of the rheumatology and immunology department.

Following that, everyone copied and pasted this exact sentence, flooding the screen.

Speechless.

Gu Huaiming suddenly found it rather amusing. Usually, Director Zhu's catchphrase was extremely arrogant, essentially implying that aside from him, no one else knew how to practice medicine.

He hadn't expected old Zhu to have a day like this!

Director Gu thought for a moment. Instead of making a phone call, he went straight to his boss's home to report everything that had happened recently face-to-face.

Presuming the boss learned that upon returning to his hometown, Luo Hao had not only failed to let his studies lapse, but had instead forged ahead with formidable vigor, he should be quite pleased.

...

...

Luo Hao looked smilingly at the system panel.

The diagnostic assistance AI was truly wonderful, and not just ordinarily wonderful!

While it didn't directly hand over the diagnosis and still required various examinations, it could pinpoint the truth amidst the intricate and chaotic details.

Awesome!

He was one step closer to returning to Peking Union.

When he shared this good news with Dr. Zou, she didn't show excessive excitement. Over the past few days of contact with Luo Hao, Dr. Zou had developed an extremely strong sense of trust in him based on her professional judgment.

This was a doctor's intuition.

After seeing Dr. Zou off, Luo Hao finally relaxed.

He hadn't expected that a patient admitted on a snowy day would take this many days to barely resolve the issue.

Relaxing, Luo Hao cast his gaze toward the long-term main quest.

As for the two members under the medical team, Cui明宇 (Cui Mingyu) was rolling up his sleeves and grinding away furiously every day, performing more surgeries than even he did. Luo Hao was quite satisfied with this.

As for the other member...

Chen Yong was hugging his mobile phone, beaming with radiant joy, his fingers typing away on WeChat with the speed of afterimages.

Luo Hao furrowed his brow.

If things went on like this, wouldn't the "position" on the medical team be handed to Chen Yong for nothing?

He had been busy lately, and this scoundrel Chen Yong had actually taken the opportunity to slack off. Unforgivable!!

Chen Yong, busy? Luo Hao asked with a smile.

Something the matter? Chen Yong didn't even raise his head as he asked with mild irritation.

Let me test you with a question. If you figure it out, you can go ask the girls.

What kind of interesting question could you possibly have? Chen Yong made no effort to conceal his disdain for Luo Hao.

There was a green frog still watching television at 7 AM when someone knocked on the door 7 times. It turned out to be the frog's good friend bringing a surprise breakfast.

He brought the frog's seven favorite foods: chocolate pie, cheese, chocolate candy, bread, fried rice, milk, and a live fly!

What do you think the frog should open first?

Huh? Say that again.