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.
我是一個製程工程師。 我知道關於鍋爐和焚化爐的一切, 包括像織物過濾器和旋風分離器一樣的東西。 但我也患有馬凡氏症候群。 它是一個遺傳性疾病。 在1992年, 我參加了一項基因研究, 我驚恐的發現,如同你從投影片上所看到的, 我的升主動脈不在底下那條綠線標示出的 正常範圍之內。 在座的每位的升主動脈都會在 3.2 到 3.6 公分之內, 而我的是 4.4. 如你所見, 我的主動脈不斷的擴大, 而我也離需要手術的階段 越來越近。
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.
這項手術有些可怕 - 麻醉你後將你的胸腔打開, 將你接上人工心肺儀器, 將你的身體溫度降到大約攝氏18度左右, 停止你的心臟跳動,切除大動脈, 替換上人工瓣膜和人工大動脈, 最後,最重要的, 你將一輩子需要使用華法令阻凝劑的 抗凝療法。 手術這件事情聽起來不是很吸引人, 而需要使用華法令阻凝劑的這個想法 讓我感到非常害怕。
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.
所以我告訴自己,我是一名搞研究開發的工程師, 這只是一個像水管的問題, 我可以自己搞定,我可以改變它。 於是我開始嘗試 改變對於動脈擴張的 全部療程。 我的目標非常簡單。 有著馬凡氏癥候群的人的升大動脈的 唯一真正地問題 就是它缺乏張力。 所以有一個可能便是 將血管從外面包住, 它便可以保持穩定並正常的運作。 如果你的高壓水管, 或你的高壓液壓管路有一點點的膨脹, 你只需要用一些膠帶纏繞住它的外面。 這個原理非常簡單, 但在執行上卻恰恰相反。 這種外部的支撐對我有一個很大的好處, 那就是我可以保持我自己身體的部份, 我自己所有的內皮和瓣膜, 以及不需要任何的抗凝療法。
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.
那我們從哪裡開始呢? 這是我的一個矢狀切片, 你可以看到在中間 有個很小的結構在往外擠壓。 那是左心室 在通過主動脈辦 - 你可以看到主動脈瓣的兩個瓣膜在工作 - 往升大動脈中壓血。 而升大動脈的 擴大和最終的破裂 終將致命。 我們從排列核磁共振 和電腦斷層掃描 得到的照片開始, 來為患者的大動脈 建造一個模型。
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.
這是我的大動脈的模型。 我的口袋裏面有一個真的模型, 如果有人想看並把玩一下。
(Laughter)
你可以看到,它的構造有些複雜。
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.
它下方一個奇怪的三葉形的形狀 包括了主動脈瓣。 接著它慢慢變成了圓形, 並逐漸變細。 所以的確是個滿難建造的 一個架構 這個,就像我說的,是我的電腦輔助設計出來的模型, 而這個是最新的模型之一。 爲了建造更好的模型, 我們經歷了很多反複的步驟。 當我們建造這個模型的時候, 正如你所見, 我們利用快速成型技術, 一種工程技術, 把它變成了一個實體塑料模型。 我們接著用先前的模型 來生產一個完全預製的 以之前的模型為形狀 完全適合大動脈的 多孔紡織網。 所以這是完完全全的 最好的個體化醫療。 我們的每一個病患 都有一個完全為他們訂製的植入物。
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.
當你建造了它后,裝上它還算簡單。 John Pepper,上帝保佑他, 他是一位心胸外科的教授 - 在他的生涯中,之前從未做過這個手術。 他將第一個放進去后,覺得不怎麼好,拿了出來,又放了第二個進去。 然後我開心的離開了。 躺在手術臺上四個半小時,然後一切都搞定了。 所以手術植入其實是最簡單的部份。
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.
如果你將我們的新療法和現有的 所謂的複合主動脈根部移植物來做比較, 有兩個讓人吃驚的發現。 我待會會很清楚的展現在各位面前。 裝我們的裝置需要花兩個小時, 而現有的治療卻需要 六個小時。 現有的治療,就像我所提到的, 需要人工心肺儀器, 並需要完全的冷卻人體。 我們都不需要上面說的那些; 我們是在一個跳動的心臟上做手術。 醫生將你的胸腔打開,在對的溫度下,和你的心臟持續跳動之時 揀出大動脈。 你的血液循環系統也不需要被打斷。 所以它真的很好。 但對我來說,最好的一點
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.
是不需要任何的抗凝療法。 除了我選擇吃的養生藥物之外, 我不需要吃任何的藥。 (笑聲)
(Laughter)
事實上,如果你和長期使用華法令抗凝療法的人交談,
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.
你會發現華法令對生活的品質有著嚴重的損害。 更糟的是, 它不可避免的會縮短你的生命。 同樣的,如果你選擇了人造瓣膜, 當你有任何的侵犯性的治療時, 你都需要使用抗生素療程。 連去牙醫那你都需要吃抗生素 來預防任何瓣膜的內部感染。 而我,完全不需要這些,所以我是完全自由的。 我的大動脈被治好了,我不需要擔心它, 這對我來說是一個重生。
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.
重新回到我演講的主題: 在跨越多個領域的研究中, 一個習慣和鍋爐工作的製程工程師 是如何建造一個完全改變他自己生命的 醫療儀器? 一個跨領域的團隊是這個問題的答案。 這是中心團隊的人員列表。 就像你所看到的, 它不僅僅包括了兩個大的領域, 醫學和工程學, 也包括了這兩種領域中的 各種專業人員。 John Pepper 是 為我動手術的那位心臟外科醫生。 但名單中的每一位都做出了一定的貢獻。 Raad Mohiaddin 是醫療放射專家: 我們需要高質量的圖像 來建造電腦輔助冠狀動脈模型。 Warren Thornton 仍然在為我們建造所有的模型。 他需要為每一個預訂的模型 從一個相當困難的數據輸入資料中 寫一個特殊的電腦輔助模型編碼。
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.
但這仍然有些障礙以及問題。 行業術語是很大的一個。 我認為在座的每一位應該都不知道 前面這四個行業術語。 在座的工程師們 可以認出快速成型和電腦輔助設計。 在座的醫療行業的,如果有的話,可以認出前兩個。 但在座的沒有人 可以明白全部的四個詞。 將行業術語剔除 對確保團隊中的每個人 在一個詞被使用時 能夠明白它的意思,非常的重要。
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.
各個行業習慣的不同也非常有趣。 透過我,我們得到了很多橫切圖像, 製造這些切片圖像並用他們來建造電腦輔助設計模型。 我們建造的第一個模型, 外科醫生在把玩了這個塑料模型後 不太能夠完全理解。 然後我們意識到它是真的大動脈的 翻版。 它是一個鏡像圖像 因為在現實中我們總是從上面的角度往下看, 房子或者是街道的規劃圖或地圖。 在醫學的世界中,他們是由下往上看規劃圖, 所以橫切圖像是完全相反的。 所以我們也要注意行業的習慣。 每個人都需要明白 什麽是假設的,什麽是沒有被假設的。
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.
制度性障礙 是項目中另一個讓人頭痛的問題。 布朗普頓醫院在被 帝國學院的醫學院接管後, 兩個機構之間存在著 非常嚴重的問題。 我在和帝國和布朗普頓合作的時候, 因為兩者之間的問題使得我們的計畫產生了一些嚴重的問題, 一些其實根本就不應該存在的問題。
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.
研究和倫理委員會: 如果你想在手術中做些新的嘗試, 你必須先從當地的研究和倫理委員會處獲得許可證。 我確定波蘭也是這樣的。 那將會有一些類似的程序 來許可新的類型的手術。 我們不僅僅有著和這有關的官僚問題, 我們還遭到了一些同行的嫉妒。 有些在研究和倫理委員會的人 並不希望 John Pepper 再次成功, 因為他已經是如此的有成就。 所以他們對我們造成了很多多餘的問題,
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.
官僚問題: 當你有一個新的療程的時候, 最終你必須給國內的每個醫院寄出一個 指導說明。 在英國,我們有國家衛生醫療質量標準署,簡稱NICE。 你們在波蘭毫無疑問的也有類似的機構。 我們必須通過NICE這一關。 我們現在在網路上有一個很好的臨床指導書。 所以每個有興趣的醫院 都可以上網讀這份報告, 和我們聯繫,然後自己可以開始進行這項手術。
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.
資金障礙: 資金來源是另一個需要考量的大問題。 另一個個跟理解這個願景的情況的大問題是 當我們第一次跟英國提供這種資金援助的 大的慈善機構之一接洽的時候, 從他們的角度看,根本是一個工程提案。 他們看不懂; 因為他們是醫生,他們僅次於上帝。 所以它肯定是垃圾。 於是他們將它扔了。 所以最後,我放棄了。 我轉而去找私人投資者。 但大多數的研究開發資金來源都是來自於 波蘭科學學院, 或者是工程物理研究院類似的機構, 然後你必須通過這些人的審核。
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.
當你嘗試跨領域工作時,行業術語是 一個大問題。 因為在工程師的世界裡, 我們都懂什麼是CAD和R.P. -- 但醫療世界工作者卻不會懂。 我覺得最終,贊助的機構一定要開始有所作為, 要開始和其他機構溝通, 並且開始運用一些想像力。
(Laughter)
如果不是個太過份的要求的話,
Which it probably is.
但事實上可能是。
(Laughter)
我創造了一個叫做”妨礙性保守主義“ 的詞。
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."
很多醫療世界中的人不想要改變, 特別是當一個工程師突然莫名其妙的跳出來並帶來了答案。 他們不想改變。 他們只想做以前一直都在做的。 事實上,很多英國的外科醫生 仍然在等著我們病患中的某個人 發生一些問題, 好讓他們可以說: 『你看!我跟你說那個是不好的。』 我們目前有30個病患。 我的手術到現在已經7年半。 所有的病患手術後加起來的時間有90年, 但我們到目前都沒有任何問題。 但還是有英國人在說, 『喔,那個外部大動脈支撐喔,它不會有效的。』
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.
這真的是個問題,真的是個問題。 我確定在座的每位都在 醫療界,醫生,外科醫生那裡經歷過傲慢的態度。 這僅僅是 醫生們保護他們自己的折衷方法。 『我當然要照顧我的病患。』 我覺得這種想法是不好的,但你看。這是我的想法。
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.
自傲,當然,也是 一個很大的問題。 當你在一個跨領域的團隊裏面工作, 你必須相信你的隊友, 必須表達對他們的支持。 Tom Treasure,一位心胸外科教授, 令人難以置信的一個人。 尊重他是件很容易的事情。 他給我尊重?這就有點不同了。
(Laughter)
這些都是不好的消息。
That's all the bad news. The good news is, the benefits are stonkingly huge. Translate that one! I bet they can't.
好消息是它的益處非常的大。 翻譯這個。我賭他們不能。 (笑聲)
(Laughter)
當你有一群
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.
有不同的專業訓練和經驗的人, 他們不僅僅有著不同的知識基礎, 他們也對每個事物有不同的觀點。 如果你能將這些人都聚在一起 讓他們開始交流並且互相理解對方, 結果將會是非常的好。 你可以找到新的解決方案,非常新的方案, 甚至是從來沒有被看過的, 非常,非常的快和容易。 使用這些延長的知識庫, 你便可以減少很多的工作量。 結果便是 一個使用科技和你周遭的知識 的一個完全不同的方式。
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.
這一切的結果便是 在很小的資金下 可以獲得很快的進展。 我對從我的想法到接受手術植入變為現實 花了多麼少的錢而感到羞愧, 所以我並不打算告訴你們花了多少錢。 因為我認為 完全的標準手術療程是存在的, 可能在美國是有的。 這樣的情況下 在一個病患上的花費 都比從將我的夢想到變為真實 的花費來得更多。
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.
以上是我所想說的,而我還有三分鐘的時間。 所以Heather將會很開心。 如果你有任何問題,請待會上來跟我聯繫。 這將是我的榮幸。感謝大家。
Many thanks.
(Applause)