Chapter 224 - 152: Subversion
In response to his mentor's chiding, Jiang He said, "Professor, please have a look first. We can talk after you've read it."
Yang Xu frowned slightly, but out of his deep trust in Jiang He, he finally reached out and took the paper.
He first glanced at the title: A Novel Multi-Biomarker Scoring System for the Early Prediction of Severe Acute Pancreatitis.
Then, he skipped the abstract and introduction, flipping directly to the core methodology and results sections.
'Let's just see what you've written!'
「Half an hour later.」
Yang Xu had been humbled.
He was now just a dazed figure, flipping back and forth through the data.
Actually, the paper's logic wasn't complex.
Like LNR, it was more of a statistical paper.
But as a Chief Physician, he understood the significance of these five indicators far better than any student could.
Once pancreatitis develops, pancreatic enzymes are activated within the pancreas, leading to autodigestion.
At this point, CRP (C-reactive protein) would rise rapidly. This is the most fundamental warning sign of an inflammatory response.
Next, the necrotic pancreatic tissue becomes susceptible to bacterial infection, triggering Systemic Inflammatory Response Syndrome (SIRS). Consequently, two immune indicators, PCT (procalcitonin) and IL-6 (interleukin-6), would immediately skyrocket.
Once this cytokine storm takes hold, the microcirculation and distal organs are the first to be impacted.
A BUN (Blood Urea Nitrogen) level over 20 signifies that the patient is already developing early-stage intravascular volume depletion and renal impairment.
Meanwhile, the presence of a pleural effusion indicates that capillary permeability has systemically changed. Exudate begins to accumulate in the pleural cavity, starting the countdown to respiratory failure.
These five indicators.
They formed a closed loop, covering three dimensions: local inflammation, systemic immune dysregulation, and early organ damage.
The multivariable logistic regression analysis showed that the scoring system's AUC (Area Under the Curve) value for predicting SAP reached a stunning 0.92.
The correlation was incredibly strong.
If the data in this paper wasn't fabricated... what did that mean?
It meant that just by drawing a vial of blood and taking a chest X-ray in the emergency department, a doctor could accurately predict whether a patient would develop a severe case two days before they went into shock or suffered multi-organ failure!
Yang Xu felt his heart begin to race.
His breathing grew heavy.
Just a few days ago, a patient with severe acute pancreatitis had died in the Second General Surgery Department.
When that patient first arrived, he only presented with ordinary abdominal pain, and his routine lab results all seemed manageable.
The emergency department followed standard procedure: NPO, acid suppression, and fluid resuscitation.
But on the evening of the third day, his condition took a sudden nosedive. He developed a high fever and Acute Respiratory Distress Syndrome (ARDS). Less than twenty-four hours after being transferred to the ICU, he was gone.
The family hadn't protested with banners like in today's incident, but Yang Xu still vividly remembered the scene of their heart-wrenching sobs echoing in the hallway.
'Why did he die?'
'Because by the time doctors could see with their own eyes that he wasn't going to make it, his organs had already started to fail!'
Jiang He's previous LNR theory was incredible, but that was a prognostic guide for post-operative cancer patients.
But this... this was different.
This was about early prediction!
This was an iron gate slammed shut right in front of death's door!
How many people suffer from acute pancreatitis globally each year? If this scoring system was rolled out in emergency departments, how many lives could it save?
Yang Xu slowly lowered the hand holding the paper.
He looked up, his eyes filled with utter shock.
'Originally, I thought this kid was a surgical genius.'
'Then, after LNR was published, I thought he was a research prodigy.'
Now, Yang Xu finally understood:
'This is fucking beyond genius. There's definitely something special about this kid!'
"Jiang He."
"Professor, I'm listening."
"How did you choose these five indicators?"
Jiang He gave his standard line: "I worked backward from the underlying pathology, plus a little bit of luck..."
Yang Xu fell silent.
'Worked backward? Easier said than done.'
'So many top pancreatic centers around the world are all researching how to reduce the mortality rate of SAP. How is it that they couldn't figure it out, but you did?'
''A little bit of luck?' More like an insane amount of luck!'
Ultimately, however, he was just glad.
'Thank God Jiang He is my student. Thank God Jiang He was born in this country.'
Yang Xu calmed himself and asked, "Where are you planning to submit this paper?"
"The *New England Journal of Medicine*. If that doesn't work out, I'll submit it to *The Lancet*."
"Good. Very good."
Yang Xu nodded.
The quality of this paper and its significance for clinical guidance were absolutely worthy of one of the top four medical journals.
The office fell silent once more.
Yang Xu stared at the paper on the desk, his thoughts beginning to run wild.
Following the standard operating procedure of the international academic community,
once this paper was published in the *New England Journal of Medicine* or *The Lancet*, it would undoubtedly send shockwaves through the global emergency medicine and pancreatic surgery communities.
Those international academic gatekeepers who stubbornly clung to the old Ranson and APACHE II scores would definitely be skeptical at first.
Then, they would pull a decade's worth of medical records from their own hospitals to perform a retrospective validation.
The validation would inevitably prove the accuracy of this "Jiang Scoring System" (as he'd tentatively call it).
Two to three years later, after validation with multi-center global clinical data, this system would be formally written into international emergency and pancreatic surgery guidelines.
By then...
Yang Xu's breath hitched for half a second.
As the corresponding author of this top-tier paper that would change clinical pathways worldwide.
On the strength of this monumental achievement that would tangibly reduce the mortality rate of severe acute pancreatitis nationally, and even globally.
He, Yang Xu, head of the Department of Hepatobiliary Surgery at Affiliated Hospital No. 1.
Could absolutely use this achievement to apply for the First-Class National Science and Technology Progress Award!
'And after winning the first-class award?'
'Induction into the national academies...'
Yang Xu's pupils dilated slightly.
He wasn't even fifty this year.
In the medical world, that was the prime of a scholar's career.
He couldn't help but swallow hard.
'Holy shit... Is Jiang He really going to just carry me all the way to becoming an academician...'
'Wait a minute, which one of us is the teacher again?'