I'm a process engineer, I know all about boilers and incinerators and fabric filters, and cyclones, and things like that. But I also have Marfan syndrome. This is an inherited disorder. And in 1992, I participated in a genetic study, and found to my horror, as you can see from the slide, that my ascending aorta was not in the normal range, the green line at the bottom. Everyone in here will be between 3.2-3.6, and I was already up at 4.4. And as you can see, my aorta dilated progressively, and I got closer and closer to the point where surgery was going to be necessary.
我是一个工艺工程师。 我知道所有锅炉和焚烧炉的一切, 包括像织物过滤器和旋风分离器一样的东西。 但是我也患有马凡氏综合征 这是一种遗传性疾病 1992年开始 我参加了一个基因研究 正向你们在幻灯片中看到的,我惊恐的发现, 我的主动脉压不在一个正常值范围内 下面的绿色区域是正常值。 在这儿的所有人都应该在3.2到3.6厘米之内 而我的则在4.4。 向你所看到的, 我的动脉扩张速度越来越快。 手术也越来越 成为必要的治疗。
The surgery on offer was pretty gruesome. Anesthetize you, open your chest, put you on an artificial heart and lung machine, drop your body temperature to about 18 centigrade, stop your heart, cut the aorta out, replace it with a plastic valve and a plastic aorta. And most importantly, commit you to a lifetime of anticoagulation therapy. Normally, warfarin. The thought of the surgery was not attractive. The thought of the warfarin was really quite frightening.
手术非常可怕 - 首先将麻醉你,打开你的腹腔 将你转换上人工心肺机器, 将你的体温降低到到18摄氏度, 停止你的心跳,切除大动脉, 用一个塑料瓣膜和大动脉取代, 而最重要的是, 你将一生都需要接受使用华法林 的抗凝治疗。 采取手术的方法不是我所愿意的 而需要使用华法林治疗的想法 是真的很可怕。
So I said to myself, "I'm an engineer, I'm in R&D, this is just a plumbing problem." "I can do this, I can change this." So I set out to change the entire treatment for aortic dilation. The project aim is really quite simple. The only real problem with the ascending aorta in people with Marfan syndrome is that it lacks some tensile strength. So, the possibility exists to simply externally wrap the pipe, and it would remain stable and operate quite happily. If your high-pressure hose pipe or hydraulic line bulges a little, you just wrap some tape around it, it really is that simple. In concept, though not in execution. The great advantage of an external support, for me, was that I could retain all of my own bits, all of my own endothelium and valves, and not need any anticoagulation therapy.
所以我对自己说,我是一名搞研究开发的工程师, 而这只是一个管道的问题。 我可以这样做。我可以更改此设置。 所以我开始 改变整个治疗 主动脉扩张的方法 项目的目的是很简单的。 马凡氏综合征的人的 升主动脉的真正问题 是它缺乏一些拉力。 所以简单的在管道的外层包装 的可能性是存在的。 这样它便会保持稳定并且很好的发挥作用。 如果您的高压软管 或您的高压液压线,变涨一点, 您只需要在它的外部缠绕一些胶带。 概念上来说,它真的就这么简单, 但实行上却恰恰相反。 外部支持对我来说最大的好处是 我可以保留所有我自己的身体部分, 所有我自己的内皮细胞和瓣膜, 并且不需要任何的抗凝治疗。
So, where do we start? This is a sagittal slice through me. In the middle, you can see that little structure squeezing out, that's the left ventricle, pushing blood out through the aortic valve. You can see two of the leaflets of the aortic valve working there. Up into the ascending aorta. And it's that part, the ascending aorta, which dilates and ultimately bursts, which of course is fatal. We started by organizing image acquisition from magnetic resonance and CT imaging machines, from which to make a model of the patient's aorta.
所以我们从哪里开始? 好,这是我的矢状切片。 你可以看到在中间 有个很小的结构在往外压挤。 这是左心室 通过主动脉阀挤压血液 - 你能看到两个的主动脉瓣的工作 — 到升大动脉。 就是这一部分升大动脉 不停的扩张并最终破裂, 造成致命的后果。 我们开始通过核磁共振成像仪器和 电脑断层扫描来 采集图像, 为病人的制造主动脉的 模型。
This is a model of my aorta. I've got a real one in my pocket, if anyone would like to look at it, and play with it.
这是一个我的主动脉模型。 我也带着一个真模型, 如果任何人想看看它,玩玩它。
(Laughter)
你可以看到,它是相当复杂的结构。
You can see it's quite a complex structure. It has a funny tri-lobal shape at the bottom, which contains the aortic valve. It then comes back into a round form, and then tapers and curves off. It's quite a difficult structure to produce. This is a sort of CAD model of me, and this is one of the later CAD models. We went through an iterative process of producing better and better models. When we produced that model, we turned it into a solid, plastic model, as you can see, using a rapid prototyping technique, another engineering technique. We then used that former to manufacture a perfectly bespoke porous textile mesh, which takes the shape of the former and perfectly fits the aorta. So this is absolutely personalized medicine at its best, really. Every patient we do has an absolutely bespoke implant.
在它的底部有一个有趣的三叶形形状, 其中包含主动脉瓣。 接着它慢慢变成了圆形, 然后逐渐变细。 所以它是一个相当难生产的 结构。 就像我说的,这是一个 CAD 模型, 这是之后众多的CAD模型之一 我们经历了一个生产更好和更好的模型 的迭代过程。 当我们制作这个模型的时候 我们把它变成一个实体的塑料模型 正如您所看到的 利用快速成型技术, 另一种工程技术。 然后,我们使用它 来制造完全订制的 以之前的模型为形状的 完全适合大动脉的 多孔纺织网。 因此,这是完完全全的 最好的个体化医疗。 我们的每一个病患 都有一个完全為他们订制的植入物。
Once you've made it, the installation is quite easy. John Pepper, bless his heart, professor of cardiothoracic surgery. Never done it before in his life, he put the first one in, didn't like it, he put the second one in. Happy, away I went. Four and a half hours on the table, and everything was done. So the surgical implantation was actually the easiest part.
一旦你做好它,安装很容易。 John Pepper, 胸心外科教授 - 从未做过这个手术 - 他植入第一个后,不喜欢它,把它取出来,又植入了第二个。 然后我开心的离开了。 手术桌上的四个半小时,所有事情都完成了。 所以外科植入其实是最容易的部分。
If you compare our new treatment to the existing alternative, the composite aortic root graft, there are one or two startling comparisons which I'm sure will be clear to all of you. Two hours to install one of our devices, compared to 6 hours for the existing treatment. As I said, the existing treatment requires the heart-lung bypass machine, and it requires a total body cooling. We don't need any of that. We work on a beating heart. He opens you up, he accesses the aorta while your heart is beating, all at the right temperature. No breaking into your circulatory system. So it really is great.
如果你比较一下我们的疗程和现有的替代方法, 所谓的复合主动脉根部移植物, 会有两个令人吃惊的比较, 明显的展现在各位眼前。 植入我们的设备需要两个小时 而现有的治疗需要 六个小时。 正如我说的,现有的替代治疗需要 人工心肺机器, 并需要完全的人体冷却。 我们不需要任何这些设备;我们在治疗一个跳动的心脏 他打开你的胸腔,在适当的温度下, 在你心脏跳动的时候接触到你的主动脉。 你的血液循环系统也不需要被打断。 所以真的非常好。 但对我来说,最好的一点
But for me, absolutely the best point is, there is no anticoagulation therapy required. I don't take any drugs at all, other than recreational ones that I would choose to take.
是完全不需要抗凝治疗。 我根本不需要使用任何药品, 除了我选择吃的消遣性的药物。 (笑声)
(Laughter)
事实上,如果你和那些在长期进行华凡林治疗的人交谈,
And in fact, if you speak to people who are on long-term warfarin, it is a serious compromise to your quality of life, and even worse, it inevitably foreshortens your life. Likewise, if you have the artificial valve option, you're committed to antibiotic therapy whenever you have any intrusive medical treatment, even trips to the dentist require that you take antibiotics, in case you get an internal infection on the valve. Again, I don't have any of that, so I'm entirely free, my artery is fixed. I haven't got to worry about it, which is a rebirth for me.
它对你的生活质量有着严重的损害。 更糟的是, 它不可避免的缩短你的生命。 同样,如果您选择了人工瓣膜, 当你接受任何有侵犯性的治疗的时候, 你都需要使用抗生素疗程。 甚至于连去牙医都需要使用抗生素, 来预防任何的瓣膜的内部感染。 再次,我完全没有以上的担忧,所以我是完全自由的。 我的主动脉已经治好了,我不需要担心它 这对我来说是一个重生。
Back to the theme of the presentation, multidisciplinary research, how on earth does a process engineer used to working with boilers end up producing a medical device which transforms his own life? Well, the answer to that is, a multidisciplinary team. This is a list of the core team, and you can see there aren't only two principal technical disciplines there, medicine and engineering, but also, there are various specialists from within those two disciplines. John Pepper was the cardiac surgeon who did all the actual work on me. But everyone else had to contribute one way or another. Raad Mohiaddin, a medical radiologist. We had to get good-quality images from which to make the CAD model. Warren Thornton, who still does all our CAD models for us, had to write a bespoke piece of CAD code to produce this model from this really rather difficult input data set.
回到演讲的主题: 在多学科研究领域内, 一个习惯与锅炉打交道的工艺工程师是怎样 建造了一个医疗设备 并改变了自己的生命? 答案就是一个跨领域的团队。 这是核心团队的名单。 就像你所看到的, 它不仅仅包括了两个大的领域, 医学和工程学, 也包括了这两种领域中的 各种专业人员。 John Pepper 是给我做手术的心脏外科医生。 而这里面的每个人都做出了一定的贡献。 Raad Mohiaddin,医疗放射学家: 我们需要获取高质量的图像 来制作 CAD 模型。 沃伦 · 桑顿仍为我们做我们所有的 CAD 模型。 它需要为每一个预订的模型 从比较生涩的输入数据库中 写一个特殊的 CAD 编码。
There are some barriers to this, though, there are some problems. Jargon is a big one. I would think no one in this room understands the first four jargon points. The engineers amongst you will recognize "rapid prototyping" and "CAD." The medics amongst you, if there are any, will recognize the first two, but there will be nobody else here that understands all those four words. Taking the jargon out was very important to ensure that everyone in the team understood exactly what was meant when a particular phrase was used.
尽管这样还有一些困难和问题存在。 行业术语是个大问题。 我认为在这个房间里没有人懂 这四个行业术语的意思。 你们之中的工程师 知道快速成型和 CAD。 你们当中的医生可能认识前两个。 但这个房间里没有任何一个人 知道全部四个。 将行业术语剔除 对确保团队中的每个人都能 在一个词条被使用时 明白它的意思,非常重要。
Our disciplinary conventions were funny as well. We took a lot of horizontal slice images through me, produced those slices and used them to build a CAD model. And the very first CAD model we made, the surgeons were playing with it and couldn't quite figure it out. And then we realized that it was actually a mirror image of the real aorta. And it was a mirror image because in the real world, we always look down on plans, plans of houses, or streets, or maps. In the medical world, they look up at plans. So the horizontal images were all in inversion. So, one needs to be careful with disciplinary conventions. Everyone needs to understand what is assumed and what is not.
我们行业习惯的不同也非常的有趣。 我们做了很多我的水平切片图像 生产这些切片,然后使用它们建立 CAD 模型。 我们的第一个CAD模型 外科医生们在把玩了这个塑料模型后, 都搞不明白是怎么回事。 然后我们意识到这是实际上一个真正的主动脉 的镜像图像。 它是一个镜像图像, 因为在现实世界中我们总是向下看规划图, 房子或街道的规划图。 在医学中我们向上看 所以那些水平图像都反转了。 所以每个人都需要注意行业的习惯。 每个人都需要了解 什么是假设了的,什么没有被假设。
Institutional barriers were another serious headache in the project. The Brompton Hospital was taken over by the Imperial College School of Medicine. And there are some seriously bad relationship problems between the two organizations. I was working with the Imperial and the Brompton, and this generated some serious problems for the project. Really, problems that shouldn't exist.
制度性障碍 在项目中是另一个让人头痛的问题。 布朗普顿医院被 帝国学院医学院的医学院接管了, 而两个组织之间 有一些严重的关系问题。 我在和帝国和布朗普顿工作, 这就产生了一些严重的问题, 真的不应该存在的问题。
Research & Ethics Committee. If you want to do anything new in surgery, you have to get a license from your local Research & Ethics. I'm sure it's the same in Poland. There will be some form of equivalent which licenses new types of surgery. We didn't only have the bureaucratic problems associated with that, we also had professional jealousies. There were people on the Research & Ethics committee who really didn't want to see John Pepper succeed again. Because he is so successful. And they made extra problems for us.
研究与伦理委员会: 如果你想做任何新的手术, 你要从您的本地研究和伦理获得许可证。 我确信在波兰也是这样的。 会有某些相同的模式, 颁发新的的手术许可证。 我们不是仅遇到了官僚主义的问题 也遭到了一些同行的猜忌。 有些研究和伦理委员会的人 不希望看到John Pepper再次成功, 因为他已经是如此的成功, 并且他们为我们设置更多的问题和麻烦。
Bureaucratic problems. Ultimately, when you have a new treatment, you have to have a guidance note for all the hospitals in the country. In the UK, we have the National Institute and Clinical Excellence. You have an equivalent in Poland, no doubt. And we had to get past the NICE problem. We now have a great clinical guidance, out on the net. So any other hospitals interested can come along, read the NICE report, get in touch with us, and then get doing it themselves.
官僚主义的问题: 当你有一个新的治疗方法的时候 你必须给国内的每一个医院寄出一个 指导书。 在英国,我们有国家卫生医疗质量标准署,NICE。 毫无疑问,波兰也有相似的机构。 我们必须在NICE过关。 我们现在在网上有一个很好的临床指导书。 所以任何有兴趣的医院 可以来看NICE的报告 与我们取得联系,然后可以自己运行。
Funding barriers, another big area to be concerned with. A big problem with understanding one of those perspectives. When we first approached one of the big, charitable UK organizations that fund this kind of stuff, we essentially gave them an engineering proposal. They didn't understand it, they were doctors, next to God, it must be rubbish, they binned it. So in the end, I went after private investors, just gave up on it. Most R&D is going to be institutionally funded, by the Polish Academy of Sciences or the Engineering and Physical Sciences Research Council, or whatever. And you need to get past those people.
资金壁垒: 要关注的另一个重要领域。 理解这些情况的时候,一个大的问题是 当我们第一次接触 一个大的英国提供这类资助的慈善机构 他们看到的从根本上是一个工程提议。 他们都不懂它 ;他们是医生,他们就在上帝的身边。 所以它一定是垃圾。他们把它丢弃一边。 所以最终我去找了私人投资者 并且我放弃了那些机构。 但大多数的 研究开发项目的资金来源都是 由波兰科学院 在工程和物理研究院的机构提供, 和您需要获得这些人的同意。
Jargon is a huge problem when you try to work across disciplines, because in an engineering world, we all understand CAD and RP. Not in the medical world. I suppose the funding bureaucrats ultimately have to get their act together. They've really got to start talking to each other, and exercise a bit of imagination, if that's not too much to ask.
当你尝试着跨领域工作时,行业术语是一个大问题。 因为在工程世界里, 我们都了解 CAD 和 R.P.— 而医疗世界并不明白。 我想最终筹资的官僚们一定要开始有所作为, 开始和其他的机构沟通, 开始用一点想象力,
(Laughter)
如果这不是过分的要求 —
Which it probably is.
虽然它很可能是。
(Laughter)
我已经创造了一个短语"阻碍性保守"。
I've coined the phrase "obstructive conservatism." So many people in the medical world don't want to change. Particularly when some jumped-up engineer has come along with the answer. They don't want to change. They simply want to do whatever they've done before. And in fact, many surgeons in the UK are still waiting for one of our patients to have some sort of an episode, so that they could say, "Told you that was no good." We've actually got 30 patients. At seven and a half years, we've got 90 post-op patient years between us, and we haven't had a single problem. And still, there are people in the UK saying, "That external aortic root, it will never work, you know."
医学世界里很多人都不想改变, 尤其是当一个工程师莫名其妙的跳出来并带来了答案。 他们不想改变。 他们只是想做他们之前做过的。 事实上,有很多外科医生在英国 仍在等待我们的病人中的一两个 发生一些小插曲 这样,他们可以说,"啊,我告诉你那不好。" 我们在 7 年半的时间里, 有过30个病人。 所有的病患手术后加起来的时间有90年, 但我们没有发生过一个问题。 尽管如此,仍然在英国有人说 "哦,那是外部的主动脉支撑啊,是啊,它永远不会有效。"
It really is a problem. I'm sure everyone in this room has come across arrogance amongst medics, doctors, surgeons, at some point. The middle point is simply the way that the doctors protect themselves. "Well, of course, I'm looking after my patient." I think it's not good, but that's my view.
这真的是一个问题。这真的是一个问题。 我相信在这个房间里的每个人在某种程度上都遇到过 医务、 医生、 外科医生的傲慢。 这仅仅是 医生们保护自己的方法。 "是啊,当然,我在保护我的病人。" 我认为这不好,但你是这样的,这就是我的看法。
Egos, of course, again a huge problem. If you work in a multidisciplinary team, you've got to give your guys the benefit of the doubt, you've got to express support for them. Tom Treasure, professor of cardiothoracic surgery. Incredible guy. Dead easy to give him respect. Him giving me respect? Slightly different.
自负,当然,这也是一个巨大的问题。 当你在一个跨领域的团队里面工作, 你必须对你的同事疑中留情, 必须要对他们表示支持。 Tom Treasure,心胸外科教授: 一个令人难以置信的家伙。 非常容易给他尊重。 淡他给我尊重呢?这就稍有不同了。
(Laughter)
这些都是不好的消息。
That's all the bad news. The good news is, the benefits are stonkingly huge. Translate that one! I bet they can't.
好消息便是它的益处非常的大。 翻译这个。我敢打赌他们不能。 (笑声)
(Laughter)
当你有一群
When you have a group of people with different professional training, a different professional experience, they not only have a different knowledge base, but also a different perspective on everything. And if you can bring them together, and get them talking and understanding each other, the results can be spectacular. You can find really novel solutions that have never been looked at before, very quickly and easily. You can short-cut huge amounts of work simply by using the extended knowledge base you have. And as a result, it's an entirely different use of the technology and the knowledge around you.
得到了不同专业训练和职业经验的人, 他们不仅有不同的知识储备, 也对每个事物都有不同的观点。 如果你可以把这些人聚集在一起 并让他们开始交流和理解对方, 结果将会是非常棒的。 您可以找到新的解决方案,真正的新解决方案, 那种从没有看到过的, 非常、 非常的容易和快。 只需你能使用这些延长的知识库, 你可以减少很多的工作。 结果便是 一个完全不同的使用科技和 你周围的知识的方式。
The result of all this is that you can get incredibly quick progress on incredibly small budgets. I'm so embarrassed at how cheap it was to get from my idea to me being implanted that I'm not prepared to tell you what it cost, because I suspect there are absolutely standard surgical treatments, probably in the USA, which cost more for a one-off patient than the cost of us getting from my dream to my reality.
这一切的结果便是 你可以以很小的预算 获得很快的进展。 我对我为从我的想法变成现实 花了那么少的钱而感到羞愧, 所以我并不打算告诉你们我花了多少。 因为我怀疑, 在美国有着完全 常规性的手术疗程, 在一个病患上的成本, 都比我从我的梦想 到现实 花费的更多。
That's all I want to say, and I've got three minutes left. So, Ewa's going to like me. If you have any questions, please come up and talk to me later on, it would be a pleasure to speak with you.
这就是我想说的,我还剩三分钟。 所以 Heather 会喜欢我。 如果您有任何疑问,请之后和我联系。 能和你们交流时我荣幸。非常感谢!
Many thanks.
(Applause)