NovelsAlex Chapter 1421 Reconstruction is more difficult than repair
Chapter 1421 Reconstruction is more difficult than repair
Chapter 1421 Reconstruction is more difficult than repair
The inspection began on the afternoon of the day Chen Jianguo and his wife arrived at the research institute.
August personally pushed Chen Jianguo's wheelchair to the radiology department. Sanbo Hospital had just introduced a brand-new MRI machine six months prior, one of the most advanced clinical models in China, offering extremely high resolution for imaging delicate structures like the spinal cord. As Chen Jianguo was transferred to the examination bed, Sister Li stood behind the leaded glass of the operating room, her hands unconsciously clasped in front of her, her gaze following her husband as he was slowly pushed into the large white cylinder.
“Sister Li, don’t be nervous,” Tang Shun said softly, standing to the side. “This examination has no radiation and is painless. The whole process takes about forty minutes. You can sit in the rest area next door for a while.”
Sister Li shook her head, her gaze never leaving the glass. "I know, I'm not nervous. I'm just thinking that he hasn't had such a comprehensive examination in a long time." She paused, a bitter smile playing on her lips. "Before, when we went to other hospitals, whether top-tier or specialized, the doctors' attitudes changed as soon as they saw 'old spinal cord injury, eleven years old' on the medical record. Some said, 'No need for further examination, it won't be of much use,' others were more direct, saying, 'We've seen too many cases like this, there's nothing new to do.' Nobody was willing to really spend time on him."
Tang Shun listened in silence.
The scan lasted a full forty minutes. During this time, multiple sequences and images were acquired from various angles, including T1-weighted, T2-weighted, and STIR sequences specifically targeting the spinal cord. Lying inside the confined magnet aperture, Chen Jianguo listened to the various frequencies of tapping sounds from the machine, yet his mind remained unusually calm. Eleven years had passed; he had long since learned to maintain inner peace during the long wait.
When Chen Jianguo was wheeled out of the examination room, Mainstein was already in the adjacent viewing room retrieving the raw images that had just been transmitted. He sat in front of three high-resolution monitors connected in parallel, leaning slightly forward, his gaze moving back and forth between the grayscale images. He scanned through them layer by layer from beginning to end, stopping at several key segments, zooming in on specific areas with the mouse, and carefully examining the continuity of the spinal cord, signal intensity, and the morphology of the surrounding soft tissues. He then took screenshots and quickly jotted down a few lines of German in his notebook.
“Mr. Chen,” Mainstein turned and gestured for Chen Jianguo to come closer to the screen, “your injury is located at T5, which is the level of the fifth thoracic vertebra, completely consistent with all previous medical records. From the imaging, the spinal cord atrophy below the injury area is less severe than I expected, and the distal cauda equina is well-preserved—this is a positive sign.”
He clicked the mouse, bringing up several enlarged cross-sectional images: "However, you must see this: there is very obvious glialized scar tissue proliferation at the site of injury, the result of eleven years of accumulated chronic inflammation and repair response. These scars are like the insulating glue buildup at a cable break; they completely encase the damaged area, forming a double barrier of physical and chemical barrier. Repairing old injuries is much more difficult than repairing acute ones."
Chen Jianguo responded almost immediately, his voice not loud, but unusually firm, "Professor Mannstein, you don't need to comfort me. What I need is the truth. Tell me the worst-case scenario, and I'll feel more at ease."
Mainstein looked at him, a barely perceptible hint of approval flashing in his eyes. He had seen too many patients, some who collapsed instantly upon receiving bad news, others who fell into unrealistic fantasies. But this man before him was as calm as a stone in a deep pool.
The next step was an electrophysiological assessment, which Clara was responsible for performing.
The electrophysiology lab was dimly lit, with only the indicator lights on the instruments emitting a pale blue and dark red glow. Clara, an extremely meticulous German woman, had Chen Jianguo lie flat on the examination table and attached more than a dozen surface electrodes to his calf muscles (gastrocnemius, tibialis anterior, quadriceps, and different segments of his thigh), as well as reference electrodes at his ankles and knees. She then started the equipment, causing the machine to emit a series of precisely controlled electrical pulses through the stimulation electrodes.
Normally, these impulses are transmitted centripetally along the peripheral nerves to the spinal cord, then ascend through the spinal cord back to the brain, forming a complete reflex arc downstream, which appears as a characteristic complex muscle action potential waveform on an oscilloscope. But in Chen Jianguo's case, the signal abruptly stopped at the fifth thoracic vertebra.
Clara stared at the almost flat baseline on the screen, her brow furrowing slightly. She checked the electrode impedance, confirmed good contact, and then increased the stimulation intensity, gradually raising it from the usual twenty milliamps to fifty milliamps, triggering the scan again. The lines on the screen remained lifeless, without any discernible waveforms.
“Professor Mainstein,” she switched to German, speaking quickly but in a low voice, “there is absolutely no response below the level of injury, and no CMAP or SSEP waveforms were elicited bilaterally. This is not a simple demyelinating lesion, but a complete axonal interruption. Although the distal muscles retain their shape relatively well, the neuromuscular junction has been denervated for a long period of time.”
Mainstein walked over from the next room, stood in front of the screen, arms crossed, and silently stared at the flat line. After a few seconds, he responded in a low voice in German: “Understood. Record all parameters completely, including the stimulus threshold and the response state at maximum output.”
Chen Jianguo didn't understand German, but from Clara's suddenly furrowed brow and Mainstein's few seconds of silence, he gleaned a heavy message. It was the solemnity unique to doctors facing harsh realities—not surprise, but confirmation.
“Professor Mannstein,” Chen Jianguo spoke up, “is it very serious? Just tell me, I can handle it.”
Mannstein turned around and looked directly into Chen Jianguo's eyes. His gaze was unwavering, unavoidable, and unexaggerated.
“Serious! That’s without a doubt.” His German accent made the word “serious” sound particularly weighty. “But serious doesn’t mean incurable. Our strategy for this kind of old, complete damage is never to repair the old nerves that are already necrotic and swallowed by scar tissue—that’s a dead end. Our approach is reconstruction, allowing new nerve fibers to grow over and establish entirely new signaling pathways. The original axonal break is irrelevant; what matters is that the downstream muscles and organs remain anatomically intact. They’re just ‘out of contact.’ As long as new signals can reach them again, they can resume functioning. This is a completely different engineering approach.”
Chen Jianguo looked into Mannstein's eyes. In those grey-blue pupils, he saw the look a doctor has when speaking the truth—an almost cold honesty and the matching professional confidence.
“Then let’s do it,” Chen Jianguo said, his voice without the slightest hesitation. “Just tell me what you need my help with.”
Sister Li stood beside him, one hand always resting on Chen Jianguo's shoulder. From the moment he entered the research institute until now, that hand had almost never left him.
In addition to MRI and electrophysiological examinations, a systematic cardiopulmonary function assessment was also scheduled for the day.
Hans was in charge of this part. He was an outgoing Austrian, blond and blue-eyed, who spoke with the characteristic Viennese lightness. He had Chen Jianguo undergo a series of standardized pulmonary function tests, including forced vital capacity, forced expiratory volume in one second, maximum voluntary ventilation, and a specific assessment of diaphragmatic function. A transthoracic echocardiogram was then performed to assess cardiac structure and ejection fraction.
After the results came out, Hans gave a short whistle, turned to Mainstein, and waved the report in his hand: "Mainstein, guess what? This guy's cardiopulmonary function is better than that of a normal person his age. FVC and FEV1 are both above 110% of the predicted values, and the echocardiogram shows a left ventricular ejection fraction of 62 percent, with completely normal diaphragmatic movement."
Mannstein took the report and quickly scanned the data.
“Interesting,” he said, walking up to Chen Jianguo. “He’s been in a wheelchair for eleven years, yet his upper limbs have a high level of daily activity, and his active and passive chest movement is actually stronger than that of an average person who sits for long periods. Moreover, judging from his muscle definition and cardiopulmonary reserves, he must have maintained a fairly regular physical training regimen over a long period.”
“Professor, you’re absolutely right,” Chen Jianguo smiled. “I exercise for two hours every day at home without fail. I’ve also bought resistance bands of various weights to stretch my shoulders, back, and core. My wife—” He glanced at Sister Li, “she designed my training plan and adjusts it regularly. She said it’s okay if I can’t walk, but I can’t let my upper body become useless, and I certainly can’t let my cardiovascular system collapse.” Mainstein looked at Sister Li. The slender yet upright woman who had been standing behind her husband seemed a little embarrassed by the sudden gaze, lowered her head, but a faint smile appeared on her lips.
“Sister Li,” Mainstein said earnestly, “you’re not just a good wife; you’ve essentially acted as his therapist, nutritionist, and psychologist. Eleven years—that’s not something an ordinary person can do.”
Sister Li said softly, "I haven't studied medicine either, I just... don't want him to collapse."
“But you played these roles,” Mainstein said. “In the rehabilitation medicine systems of many countries, the role of family caregivers is severely underestimated. But I want to tell you that at least half the credit for Chen Jianguo’s current physical condition belongs to you.”
At six o'clock in the evening, the sky outside the window gradually darkened, and the motion-sensor lights in the research institute's corridor turned on one by one. All the inspections were finally completed.
Mannstein invited Mr. and Mrs. Chen to his office. It was a room at the end of the corridor, furnished almost austerely—a large oak desk, two visitor chairs, a computer connected to the hospital's intranet, and a whiteboard that took up an entire wall, densely covered with various experimental data charts, hand-drawn pathway diagrams, and sticky notes for to-do lists. In the corner was a small refrigerator containing several bottles of mineral water and a box of gingerbread biscuits that August had brought from Germany, his secret stash to relieve jet lag.
“Mr. Chen, Ms. Li, please have a seat.” Mannstein gestured to a chair, then went around behind the desk but did not sit down.
Chen Jianguo braced himself on the armrests of his wheelchair, skillfully adjusting his posture and pushing himself to the table. Sister Li sat in the chair beside him, took a gleaming thermos from her bag, unscrewed the lid, poured a cup of warm water, and gently placed it in front of Chen Jianguo. She did this with remarkable naturalness.
Mannstein observed this detail without speaking, but his gaze softened.
“Mr. Chen, let me give you a comprehensive overview of today’s test results.” Mainstein rested his hands on the table, leaning slightly forward. “There’s good news and bad news. Following your Chinese custom, you might want to hear the bad news first?”
“Listen to the bad news first,” Chen Jianguo said. “Save the good news for later; it can offset the bad news.”
"The bad news is that your injury has been confirmed electrophysiologically as a complete lesion. Nerve conduction below the level of the injury is completely interrupted, with no residual ascending or descending signaling pathways. This wasn't unexpected, but its confirmation means our intervention strategy needs to shift from 'repair' to 'reconstruction'—we need to lay a completely new neural pathway in your spinal cord from scratch, rather than trying to clear the old one. It's like not repairing an old road buried by a mudslide, but instead chiseling through the mountainside to build a completely new tunnel. It's more difficult, takes longer, and has greater uncertainty."
Chen Jianguo nodded, his expression unchanged: "Understood. Anything else?"
"The good news is that your distal muscles haven't experienced severe disuse atrophy; the shape and volume of your muscle fibers are still relatively well-maintained, thanks to your long-term active and passive training. Your cardiopulmonary function has also exceeded expectations, meaning you will tolerate the surgery and subsequent rehabilitation very well. Many people who have been in a wheelchair for eleven years have suffered comprehensive physical deterioration—osteoporosis, declining cardiopulmonary function, pressure sores, urinary tract infections, and a host of other problems. You don't have that. From a purely physiological perspective, you are ten years younger than we expected."
Sister Li's ears turned red again. She lowered her head, her fingers unconsciously rubbing the edge of the thermos.
“There’s more good news,” Mainstein continued, slowing his pace, “Your mental state is excellent. This isn’t just polite talk; it’s my honest assessment, and a crucial indicator in the enrollment evaluation. I observed you all day, and you didn’t complain, showed no anxiety, and exhibited no pathological agitation. You simply accepted all the tests calmly, listened calmly to the bad news, and provided clear and rational responses at every point requiring a decision. This mental fortitude is one of the most important conditions for participating in such high-risk, cutting-edge experiments. Technology can be improved, protocols can be optimized, but a subject who can maintain mental homeostasis under prolonged adversity is irreplaceable.”
Chen Jianguo remained silent for a while.
“Professor Mainstein,” he began slowly, “I was a policeman for nine years. During our training, one of my instructors said something that I’ve remembered ever since—'The more dangerous the situation, the calmer you must remain. Panic won’t reduce the danger; it will only impair your judgment.' The day I was injured, I fell from a flyover under construction. In those few seconds in the air, I wasn’t thinking, ‘I’m going to die,’ but rather, ‘How can I land with the least injury?’ Later, I became paralyzed and lay in the ICU. I told myself that panicking was useless, crying was useless, and the only useful thing was to survive and wait for an opportunity.”
He looked up at Mainstein: "This wait lasted eleven years."
Mannstein looked at him and remained silent for a long time.
“Mr. Chen,” he finally spoke, his voice tinged with restraint, “I can give you a preliminary assessment. From a medical perspective, you fully meet our inclusion criteria for human trials—your physical condition, psychological state, and family support system are all satisfactory. However, this isn't a decision I can make alone. We need to submit all the raw data, imaging materials, and electrophysiological records to the ethics committee for independent review. We also need to conduct multidisciplinary discussions with the hospital's neurosurgery, rehabilitation, and anesthesiology teams to assess the surgical risks and postoperative management plan. This process, according to standard procedures, will take approximately two to four weeks.”
“I’ve waited eleven years,” Chen Jianguo said, a slight smile even appearing on his lips, “two more weeks won’t make a difference.”
Mannstein stood up, walked around the desk, stood in front of Chen Jianguo, and extended his right hand.
"Mr. Chen, regardless of the final decision of the ethics committee, it is an honor to meet you today."
Chen Jianguo grasped his hand.
“Professor Mannstein, it’s an honor to meet you,” Chen Jianguo said earnestly.
P.S.: I'm really sorry, the chapter numbers in the earlier parts were mixed up. This is probably because many chapters were deleted during the drafting process. I copied the chapters from the draft and am now correcting them. Because many chapters were deleted, the plot in this part might not be as smooth as in the beginning. I'll try my best to get it organized. Thank you everyone!