Tal Golesworthy: How I repaired my own heart

翻译人员: Bruce Liu 校对人员: Dennis Guo

我是一个工艺工程师。

I'm a process engineer, I know all about boilers and incinerators

我知道所有锅炉和焚烧炉的一切，

and fabric filters, and cyclones, and things like that.

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

But I also have Marfan syndrome.

这是一种遗传性疾病

This is an inherited disorder.

And in 1992, I participated in a genetic study,

1992年开始

我参加了一个基因研究

and found to my horror, as you can see from the slide,

正向你们在幻灯片中看到的，我惊恐的发现，

that my ascending aorta was not in the normal range,

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。

the green line at the bottom.

在这儿的所有人都应该在3.2到3.6厘米之内

Everyone in here will be between 3.2-3.6,

而我的则在4.4。

and I was already up at 4.4.

And as you can see, my aorta dilated progressively,

向你所看到的，

我的动脉扩张速度越来越快。

and I got closer and closer to the point where surgery was going to be necessary.

手术也越来越

成为必要的治疗。

The surgery on offer was pretty gruesome.

手术非常可怕 -

首先将麻醉你，打开你的腹腔

Anesthetize you, open your chest,

put you on an artificial heart and lung machine,

将你转换上人工心肺机器，

drop your body temperature to about 18 centigrade,

将你的体温降低到到18摄氏度，

stop your heart, cut the aorta out,

停止你的心跳，切除大动脉，

replace it with a plastic valve and a plastic aorta.

用一个塑料瓣膜和大动脉取代，

而最重要的是，

And most importantly, commit you to a lifetime of anticoagulation therapy.

你将一生都需要接受使用华法林

的抗凝治疗。

Normally, warfarin.

采取手术的方法不是我所愿意的

The thought of the surgery was not attractive.

The thought of the warfarin was really quite frightening.

而需要使用华法林治疗的想法

是真的很可怕。

所以我对自己说，我是一名搞研究开发的工程师，

So I said to myself,

"I'm an engineer, I'm in R&D, this is just a plumbing problem."

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。

"I can do this, I can change this."

所以我开始

So I set out to change the entire treatment for aortic dilation.

改变整个治疗

主动脉扩张的方法

The project aim is really quite simple.

项目的目的是很简单的。

The only real problem with the ascending aorta

马凡氏综合征的人的

in people with Marfan syndrome

升主动脉的真正问题

is that it lacks some tensile strength.

是它缺乏一些拉力。

所以简单的在管道的外层包装

So, the possibility exists to simply externally wrap the pipe,

的可能性是存在的。

and it would remain stable and operate quite happily.

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

If your high-pressure hose pipe or hydraulic line bulges a little,

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。

you just wrap some tape around it, it really is that simple.

概念上来说，它真的就这么简单，

In concept, though not in execution.

但实行上却恰恰相反。

The great advantage of an external support, for me,

外部支持对我来说最大的好处是

was that I could retain all of my own bits,

我可以保留所有我自己的身体部分，

all of my own endothelium and valves,

所有我自己的内皮细胞和瓣膜，

and not need any anticoagulation therapy.

并且不需要任何的抗凝治疗。

所以我们从哪里开始？

So, where do we start?

好，这是我的矢状切片。

This is a sagittal slice through me.

你可以看到在中间

In the middle, you can see that little structure squeezing out,

有个很小的结构在往外压挤。

that's the left ventricle,

这是左心室

pushing blood out through the aortic valve.

通过主动脉阀挤压血液 -

你能看到两个的主动脉瓣的工作 —

You can see two of the leaflets of the aortic valve working there.

Up into the ascending aorta.

到升大动脉。

And it's that part, the ascending aorta,

就是这一部分升大动脉

不停的扩张并最终破裂，

which dilates and ultimately bursts, which of course is fatal.

造成致命的后果。

We started by organizing image acquisition

我们开始通过核磁共振成像仪器和

from magnetic resonance and CT imaging machines,

电脑断层扫描来

采集图像，

from which to make a model of the patient's aorta.

为病人的制造主动脉的

模型。

这是一个我的主动脉模型。

This is a model of my aorta.

I've got a real one in my pocket,

我也带着一个真模型，

if anyone would like to look at it, and play with it.

如果任何人想看看它，玩玩它。

(Laughter)

You can see it's quite a complex structure.

你可以看到，它是相当复杂的结构。

It has a funny tri-lobal shape at the bottom,

在它的底部有一个有趣的三叶形形状，

which contains the aortic valve.

其中包含主动脉瓣。

It then comes back into a round form,

接着它慢慢变成了圆形，

and then tapers and curves off.

然后逐渐变细。

所以它是一个相当难生产的

It's quite a difficult structure to produce.

结构。

就像我说的，这是一个 CAD 模型，

This is a sort of CAD model of me,

and this is one of the later CAD models.

这是之后众多的CAD模型之一

We went through an iterative process of producing better and better models.

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

When we produced that model,

we turned it into a solid, plastic model, as you can see,

我们把它变成一个实体的塑料模型

正如您所看到的

using a rapid prototyping technique, another engineering technique.

利用快速成型技术，

另一种工程技术。

We then used that former

然后，我们使用它

to manufacture a perfectly bespoke porous textile mesh,

来制造完全订制的

以之前的模型为形状的

which takes the shape of the former and perfectly fits the aorta.

完全适合大动脉的

多孔纺织网。

So this is absolutely personalized medicine at its best, really.

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

Every patient we do has an absolutely bespoke implant.

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.

一旦你做好它，安装很容易。

John Pepper, bless his heart, professor of cardiothoracic surgery.

John Pepper，

胸心外科教授 -

从未做过这个手术 -

Never done it before in his life, he put the first one in, didn't like it,

他植入第一个后，不喜欢它，把它取出来，又植入了第二个。

he put the second one in.

然后我开心的离开了。

Happy, away I went.

手术桌上的四个半小时，所有事情都完成了。

Four and a half hours on the table, and everything was done.

所以外科植入其实是最容易的部分。

So the surgical implantation was actually the easiest part.

如果你比较一下我们的疗程和现有的替代方法，

If you compare our new treatment to the existing alternative,

所谓的复合主动脉根部移植物，

the composite aortic root graft,

there are one or two startling comparisons

会有两个令人吃惊的比较，

which I'm sure will be clear to all of you.

明显的展现在各位眼前。

Two hours to install one of our devices,

植入我们的设备需要两个小时

而现有的治疗需要

compared to 6 hours for the existing treatment.

六个小时。

正如我说的，现有的替代治疗需要

As I said, the existing treatment requires the heart-lung bypass machine,

人工心肺机器，

and it requires a total body cooling.

并需要完全的人体冷却。

We don't need any of that. We work on a beating heart.

我们不需要任何这些设备；我们在治疗一个跳动的心脏

He opens you up,

他打开你的胸腔，在适当的温度下，

he accesses the aorta while your heart is beating,

在你心脏跳动的时候接触到你的主动脉。

all at the right temperature.

No breaking into your circulatory system.

你的血液循环系统也不需要被打断。

So it really is great.

所以真的非常好。

But for me, absolutely the best point is,

但对我来说，最好的一点

there is no anticoagulation therapy required.

是完全不需要抗凝治疗。

I don't take any drugs at all,

我根本不需要使用任何药品，

other than recreational ones that I would choose to take.

除了我选择吃的消遣性的药物。

（笑声）

(Laughter)

And in fact, if you speak to people who are on long-term warfarin,

事实上，如果你和那些在长期进行华凡林治疗的人交谈，

it is a serious compromise to your quality of life,

它对你的生活质量有着严重的损害。

and even worse, it inevitably foreshortens your life.

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，

Likewise, if you have the artificial valve option,

you're committed to antibiotic therapy

当你接受任何有侵犯性的治疗的时候，

whenever you have any intrusive medical treatment,

你都需要使用抗生素疗程。

even trips to the dentist require that you take antibiotics,

甚至于连去牙医都需要使用抗生素，

in case you get an internal infection on the valve.

来预防任何的瓣膜的内部感染。

Again, I don't have any of that, so I'm entirely free,

再次，我完全没有以上的担忧，所以我是完全自由的。

my artery is fixed.

我的主动脉已经治好了，我不需要担心它

I haven't got to worry about it, which is a rebirth for me.

这对我来说是一个重生。

回到演讲的主题：

Back to the theme of the presentation, multidisciplinary research,

在多学科研究领域内，

how on earth does a process engineer used to working with boilers

一个习惯与锅炉打交道的工艺工程师是怎样

end up producing a medical device which transforms his own life?

建造了一个医疗设备

并改变了自己的生命？

Well, the answer to that is, a multidisciplinary team.

答案就是一个跨领域的团队。

This is a list of the core team,

这是核心团队的名单。

and you can see there aren't only two principal technical disciplines there,

就像你所看到的，

它不仅仅包括了两个大的领域，

medicine and engineering,

医学和工程学，

but also, there are various specialists from within those two disciplines.

也包括了这两种领域中的

各种专业人员。

John Pepper was the cardiac surgeon who did all the actual work on me.

John Pepper

是给我做手术的心脏外科医生。

But everyone else had to contribute one way or another.

而这里面的每个人都做出了一定的贡献。

Raad Mohiaddin, a medical radiologist.

Raad Mohiaddin，医疗放射学家：

We had to get good-quality images from which to make the CAD model.

我们需要获取高质量的图像

来制作 CAD 模型。

Warren Thornton, who still does all our CAD models for us,

沃伦 · 桑顿仍为我们做我们所有的 CAD 模型。

had to write a bespoke piece of CAD code

它需要为每一个预订的模型

to produce this model from this really rather difficult input data set.

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.

尽管这样还有一些困难和问题存在。

行业术语是个大问题。

Jargon is a big one.

I would think no one in this room understands the first four jargon points.

我认为在这个房间里没有人懂

这四个行业术语的意思。

The engineers amongst you will recognize "rapid prototyping" and "CAD."

你们之中的工程师

知道快速成型和 CAD。

The medics amongst you, if there are any, will recognize the first two,

你们当中的医生可能认识前两个。

but there will be nobody else here that understands all those four words.

但这个房间里没有任何一个人

知道全部四个。

Taking the jargon out was very important

将行业术语剔除

to ensure that everyone in the team understood exactly what was meant

对确保团队中的每个人都能

在一个词条被使用时

when a particular phrase was used.

明白它的意思，非常重要。

我们行业习惯的不同也非常的有趣。

Our disciplinary conventions were funny as well.

We took a lot of horizontal slice images through me,

我们做了很多我的水平切片图像

produced those slices and used them to build a CAD model.

生产这些切片，然后使用它们建立 CAD 模型。

And the very first CAD model we made,

我们的第一个CAD模型

the surgeons were playing with it and couldn't quite figure it out.

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。

And then we realized that it was actually a mirror image of the real aorta.

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。

And it was a mirror image because in the real world,

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，

we always look down on plans,

plans of houses, or streets, or maps.

房子或街道的规划图。

In the medical world, they look up at plans.

在医学中我们向上看

So the horizontal images were all in inversion.

所以那些水平图像都反转了。

So, one needs to be careful with disciplinary conventions.

所以每个人都需要注意行业的习惯。

Everyone needs to understand what is assumed and what is not.

每个人都需要了解

什么是假设了的，什么没有被假设。

制度性障碍

Institutional barriers were another serious headache in the project.

在项目中是另一个让人头痛的问题。

The Brompton Hospital was taken over

布朗普顿医院被

by the Imperial College School of Medicine.

帝国学院医学院的医学院接管了，

And there are some seriously bad relationship problems

而两个组织之间

有一些严重的关系问题。

between the two organizations.

I was working with the Imperial and the Brompton,

我在和帝国和布朗普顿工作，

这就产生了一些严重的问题，

and this generated some serious problems for the project.

Really, problems that shouldn't exist.

真的不应该存在的问题。

Research & Ethics Committee.

研究与伦理委员会： 如果你想做任何新的手术，

If you want to do anything new in surgery,

你要从您的本地研究和伦理获得许可证。

you have to get a license from your local Research & Ethics.

我确信在波兰也是这样的。

I'm sure it's the same in Poland.

会有某些相同的模式，

There will be some form of equivalent which licenses new types of surgery.

颁发新的的手术许可证。

We didn't only have the bureaucratic problems associated with that,

我们不是仅遇到了官僚主义的问题

we also had professional jealousies.

也遭到了一些同行的猜忌。

There were people on the Research & Ethics committee

有些研究和伦理委员会的人

不希望看到John Pepper再次成功，

who really didn't want to see John Pepper succeed again.

因为他已经是如此的成功，

Because he is so successful.

And they made extra problems for us.

并且他们为我们设置更多的问题和麻烦。

Bureaucratic problems.

官僚主义的问题：

Ultimately, when you have a new treatment,

当你有一个新的治疗方法的时候

you have to have a guidance note for all the hospitals in the country.

你必须给国内的每一个医院寄出一个

指导书。

In the UK, we have the National Institute and Clinical Excellence.

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。

You have an equivalent in Poland, no doubt.

我们必须在NICE过关。

And we had to get past the NICE problem.

我们现在在网上有一个很好的临床指导书。

We now have a great clinical guidance, out on the net.

所以任何有兴趣的医院

So any other hospitals interested can come along, read the NICE report,

可以来看NICE的报告

get in touch with us, and then get doing it themselves.

与我们取得联系，然后可以自己运行。

资金壁垒：

Funding barriers, another big area to be concerned with.

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

A big problem with understanding one of those perspectives.

当我们第一次接触

When we first approached one of the big, charitable UK organizations

一个大的英国提供这类资助的慈善机构

that fund this kind of stuff,

他们看到的从根本上是一个工程提议。

we essentially gave them an engineering proposal.

They didn't understand it, they were doctors, next to God,

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。

it must be rubbish, they binned it.

所以最终我去找了私人投资者

So in the end, I went after private investors, just gave up on it.

并且我放弃了那些机构。

Most R&D is going to be institutionally funded,

但大多数的 研究开发项目的资金来源都是

by the Polish Academy of Sciences

由波兰科学院

在工程和物理研究院的机构提供，

or the Engineering and Physical Sciences Research Council, or whatever.

And you need to get past those people.

和您需要获得这些人的同意。

当你尝试着跨领域工作时，行业术语是一个大问题。

Jargon is a huge problem when you try to work across disciplines,

因为在工程世界里，

because in an engineering world, we all understand CAD and RP.

我们都了解 CAD 和 R.P.—

Not in the medical world.

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，

I suppose the funding bureaucrats ultimately have to get their act together.

开始和其他的机构沟通，

They've really got to start talking to each other,

开始用一点想象力，

and exercise a bit of imagination, if that's not too much to ask.

如果这不是过分的要求 —

(Laughter)

Which it probably is.

虽然它很可能是。

(Laughter)

I've coined the phrase "obstructive conservatism."

我已经创造了一个短语"阻碍性保守"。

So many people in the medical world don't want to change.

医学世界里很多人都不想改变，

Particularly when some jumped-up engineer has come along with the answer.

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。

They don't want to change.

They simply want to do whatever they've done before.

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

And in fact, many surgeons in the UK are still waiting

仍在等待我们的病人中的一两个

for one of our patients to have some sort of an episode,

发生一些小插曲

so that they could say, "Told you that was no good."

这样，他们可以说，"啊，我告诉你那不好。"

We've actually got 30 patients.

我们在 7 年半的时间里，

At seven and a half years,

有过30个病人。

we've got 90 post-op patient years between us,

所有的病患手术后加起来的时间有90年，

and we haven't had a single problem.

但我们没有发生过一个问题。

And still, there are people in the UK saying,

尽管如此，仍然在英国有人说

"That external aortic root, it will never work, you know."

"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.

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

I'm sure everyone in this room has come across arrogance

医务、 医生、 外科医生的傲慢。

amongst medics, doctors, surgeons, at some point.

The middle point is simply the way that the doctors protect themselves.

这仅仅是

医生们保护自己的方法。

"Well, of course, I'm looking after my patient."

"是啊，当然，我在保护我的病人。"

I think it's not good, but that's my view.

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.

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，

If you work in a multidisciplinary team,

你必须对你的同事疑中留情，

you've got to give your guys the benefit of the doubt,

you've got to express support for them.

必须要对他们表示支持。

Tom Treasure, professor of cardiothoracic surgery.

Tom Treasure，心胸外科教授：

一个令人难以置信的家伙。

Incredible guy.

Dead easy to give him respect.

非常容易给他尊重。

Him giving me respect? Slightly different.

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.

好消息便是它的益处非常的大。

Translate that one! I bet they can't.

翻译这个。我敢打赌他们不能。

（笑声）

(Laughter)

When you have a group of people with different professional training,

当你有一群

得到了不同专业训练和职业经验的人，

a different professional experience,

they not only have a different knowledge base,

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。

but also a different perspective on everything.

如果你可以把这些人聚集在一起

And if you can bring them together,

并让他们开始交流和理解对方，

and get them talking and understanding each other,

the results can be spectacular.

结果将会是非常棒的。

You can find really novel solutions that have never been looked at before,

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，

very quickly and easily.

非常、 非常的容易和快。

You can short-cut huge amounts of work

只需你能使用这些延长的知识库，

simply by using the extended knowledge base you have.

你可以减少很多的工作。

结果便是

And as a result, it's an entirely different use

一个完全不同的使用科技和

你周围的知识的方式。

of the technology and the knowledge around you.

这一切的结果便是

The result of all this is that you can get incredibly quick progress

你可以以很小的预算

on incredibly small budgets.

获得很快的进展。

I'm so embarrassed at how cheap it was to get from my idea

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，

to me being implanted

所以我并不打算告诉你们我花了多少。

that I'm not prepared to tell you what it cost,

因为我怀疑，

because I suspect there are absolutely standard surgical treatments,

在美国有着完全

常规性的手术疗程，

probably in the USA,

which cost more for a one-off patient

在一个病患上的成本，

都比我从我的梦想

than the cost of us getting from my dream to my reality.

到现实

花费的更多。

That's all I want to say, and I've got three minutes left.

这就是我想说的，我还剩三分钟。

So, Ewa's going to like me.

所以 Heather 会喜欢我。

If you have any questions, please come up and talk to me later on,

如果您有任何疑问，请之后和我联系。

it would be a pleasure to speak with you.

能和你们交流时我荣幸。非常感谢！

Many thanks.

(Applause)