godfather of surgery

Chapter 895 Cut off the beard

The European Spine Surgery Academic Conference has entered its third day.

Song Zimo and August began to perform the operation, which was arranged in the operating room of Frankfurt University Hospital.

Because the director of spine surgery here is very familiar with August, they are classmates and good friends.

The first of these three surgeries was a difficult scoliosis surgery. If this surgery had been performed before, no doctor in Europe would have dared to perform it.

When the patient's whole spine X-ray was enlarged on the huge electronic screen at the venue, more than 6,000 doctors were extremely surprised and shuddered. How could such a spinal deformity be operated on? It was almost expected that paralysis would occur after the operation.

A few doctors at the venue had experience in this area. They once had the courage to perform difficult surgeries. The degree of scoliosis they attempted was not as high as that of current surgeries. However, the final result was failure. The patient did not suffer from symptoms during the operation. Paralysis is paralysis after surgery.

Without innovation in surgical concepts and methods, these doctors believe that some scoliosis cannot be treated surgically because surgery will cause paralysis, which is not worth the gain.

What is the effect of Yang's osteotomy that Song Zimo mentioned in his speech? Now Song Zimo uses surgery to demonstrate it.

The scalpel on the screen began to cut the skin with extremely smooth movements. The scalpel cut through the skin with one stroke, just cutting through the epidermis and dermis along the entire length of the surgical incision. This is the iconic one-stroke technique that is now displayed in front of doctors all over the world.

All the experienced spinal surgeons present were impressed by this skin-cutting technique. This level of skin-cutting seemed simple, but few people could do it.

In the high-definition video, doctors can even see that the incision edge is neat, that is, the scalpel is perpendicular to the skin during the entire process, and the scalpel is very stable throughout the entire process, without any deflection, and the depth of the knife is just right. It is cut just right, but stops when it reaches the subcutaneous layer, without causing any damage to the subcutaneous fat.

After the skin, there is fascia, and then the muscles are separated from the spinous process to both sides. Gradually, the doctors discovered a strange thing. This Chinese doctor did not bleed during the operation. What was going on?

It stands to reason that this kind of spinal surgery will cause bleeding no matter how advanced the surgery is. It is just a question of how much bleeding there is. The gauze used for packing will inevitably have a few soaked pieces. But now this Chinese doctor has an electrosurgical knife or bipolar electrosurgery in his hand. The coagulation is flexible and precise, eliminating all bleeding points at the initial stage.

Not only has the gauze used for packing not been replaced, but it seems that only a little blood has been absorbed.

Hemostasis is a problem that any surgeon must face, and the skill of hemostasis is the most basic skill in surgery.

Today, all the doctors saw different surgeries, which were completely different from the surgeries they performed and the surgeries they knew.

The muscles were pushed apart subperiosteally on both sides of the spinous process, and the spinous process, lamina, and upper and lower articular processes were all exposed. The next step was to implant the pedicle screws. Now it was the third time that the world's doctors were surprised.

It only took Song Zimo less than ten minutes to place a total of twenty pedicle screws, which meant that one pedicle screw was implanted in less than half a minute. His skillful technique and fast movements surprised all the doctors present.

The fluoroscopic image of the G-arm machine during the operation was projected on the screen. The position, direction and length of the twenty pedicle screws were impeccable.

Milton watched Song Zimo perform the operation, and his chest felt a little pressed by a stone. If he were to do it himself, these twenty pedicle screws would take at least an hour to complete even with the use of a high-tech navigation system. Nails, and the position of the nails cannot be so beautiful, because the machine ultimately relies on human experience to operate.

After completing the patching, it was time to cut the osteotomy. Song Zimo already knew the location of the osteotomy. Based on the principles of Yang's osteotomy, he used calculation formulas to estimate the location of the osteotomy, and then determined the location, direction and depth of the osteotomy. .

Frankfurt University Hospital has a navigation system, but in order to demonstrate that this surgical method can be completed under simple conditions, Song Zimo did not use the navigation system and completed all steps manually.

Yang's osteotomy is based on a large amount of data research. It studies the relationship between spinal cord deformation and paralysis, spinal correction and spinal cord deformation, and the relationship between osteotomy site and spinal correction. These three relationships have been thoroughly studied, and then a Apply the formula to relate the osteotomy site to spinal cord paralysis.

In this way, the entire operation is no longer a matter of chance. Although there was detection of spinal cord evoked potentials in the past to monitor spinal cord damage, this was only monitoring. If there was an abnormality in the electric waves, the damage had already occurred.

Yang Ping's current surgical method directly connects the osteotomy site with the spinal cord injury.

If a doctor plans to perform an operation on a patient with scoliosis, he will draw the determined osteotomy site in advance, including several osteotomy points, where to cut the bone, and how much to cut, and then use Yang Ping's set of function formulas to calculate You can get a function value, which is a score, and this score is compared with the reference value.

It’s clear at a glance what score below it means you will definitely be paralyzed, and above what score you will definitely be safe.

Moreover, if the location, quantity, and degree of osteotomy are determined based on the calculation of this formula, paralysis will definitely not occur.

There is also a correction coefficient. For example, if the patient has had spinal tuberculosis before and the affected area of ​​spinal tuberculosis is affected, the function value needs to be corrected. Each situation corresponds to a coefficient. Add the coefficient to it to get a corrected value. function value.

Currently, this function is very accurate whether it is used in China or Europe.

On one side of the screen was an introduction to the function of Yang's osteotomy. Milton carefully calculated on the scratch paper. He was really a genius doctor. He could actually come up with such a method. I'm afraid it would take a lot of data collection to do it. This is another thing. He is a doctor with great patience and perseverance. Otherwise, how could he collect so much data and then analyze it.

At that time, Milton saw this kind of function in Yang Ping's paper, which introduced the statistical data of surgical cases. It only gave a rough introduction to this function, so Milton also wanted to use this method for surgery at that time. But it didn't work out even if I tried.

In fact, at that time, Yang Ping had not simplified his surgical methods. He was worried that if he explained it in too much detail, many doctors would be eager to try it without overestimating their capabilities, which would easily cause some problems.

Yang Ping's surgical method usually goes through two steps: a newly invented surgical technique, and then a simplified surgical technique to lower the threshold of surgery and the difficulty of the operation.

Now Yang Ping has simplified the technique, so he sent Song Zimo to Europe to teach it to doctors all over the world through this conference. If you follow the current method, it will be very easy. After Milton thoroughly studied this method, he decided to use this method for all scoliosis corrections in the future, especially some difficult surgeries. In the future, you will no longer have to worry about it, and you will completely rely on it. It comes down to experience and luck.

The osteotomy is very fast, and the osteotomy is completed quickly, followed by correction and rod insertion. The whole process is done in one go. It does not feel like a day of scoliosis correction, as if it is a simple spinal compression fracture. The whole process is smooth and smooth. pressure.

From skin incision to suturing, the operation ended in one hour.

The entire venue was completely impressed by Dr. Song Zimo's skills. If any of them encountered this kind of case for the first time, they would not dare to accept it and could only give up the operation.

By reducing the difficulty of the case, they can operate on the patient, but the operation time cannot be so fast. There are twenty pedicle screws and several osteotomy sites. No matter how fast the speed is, it will not take three or four hours. Surgery may be done.
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At this time, Yang Ping was busy in the system space laboratory.

He is currently working on more than one project, and is already working on two projects. The project of searching for other spatial guidance factors is still ongoing, and studying the apoptosis of tumor cells is also at a critical moment.

Moreover, Yang Ping is planning to set up a third topic in the system space laboratory. The current system points can fully support the simultaneous progress of three topics.

The third topic studied skin. Yang Ping found that skin is really a magical organ, which is obviously different from other organs.

Yang Ping's skin amplification technology does not use stem cells or spatial guidance factors, because the only spatial guidance factors found so far are muscle factors.

Skin augmentation technology only uses the patient's healthy skin, and uses this healthy skin to expand a large piece of skin. This skin still belongs to the patient's own skin, and there will be no rejection. In theory, the expanded skin The area is unlimited.

Why can the skin do this but other organs cannot?

Yang Ping now has more and more questions in his mind. He found that the deeper his research went, the more questions he had in his mind, and the questions were messy.

Yang Ping calculated the system points and decided to set up a third topic to study the skin and the liver by the way, because the liver also has a certain replication ability, which is not available in other organs.

If the liver can be expanded outside the body like skin, then all patients who need liver transplantation in the future will not need to wait for allogeneic transplantation. They will only need to take out the remaining healthy liver cells on the liver and expand and culture them outside the body. This way, they can be cultured Qualified liver tissue for transplantation is extracted and then transplanted back into the liver.

The more Yang Ping thought about it, the more he felt that the skin was a magical organ. The skin not only had the advantage of being replicable, it also had a sensitive touch. Compared with other animals, the reason why humans are far more intelligent than other animals is probably related to the sensitive touch of the skin.

A person does not need to see with his eyes, but only feels with the skin of his hands. He can feel the shape and material of an object, such as whether it is wood or iron, and can make basic judgments.

A piece of skin taken from the human body and placed outside the body can actually change to adapt to different environments, just like it has its own brain.

There must be many secrets hidden in this magical organ. Yang Ping decided to do some research. He was not only satisfied with the skin expansion technology, but why the skin can be expanded and why other organs cannot be expanded. What is the mechanism inside? This is Yang Ping's focus.

As for the subject of tumor cell death, the context is becoming increasingly clear.

After analyzing electron microscope pictures of dead tumor cells in different states, it has been determined that the way of cell death is apoptosis, and who initiates apoptosis. Through the analysis of various biochemical molecules in the environment around tumor cells, Yang Ping found Develop a special protein called K factor.

The death of tumor cells is closely related to this protein. How it is connected and what role K factor plays in this process is currently unclear and is the subject of further experimental exploration.

Through recent research, Yang Ping found that the role of K factor in the apoptosis of tumor cells is probably realized through the concept of chemically induced proximity (CIP). CIP uses a core principle of cell biology, that is, cell regulation usually An induction mechanism involving two different proteins brought into proximity with each other.

This proximity induction is the basis for many forms of biological regulation, such as receptor function, post-translational modification, transcriptional regulation, and epigenetic regulation. In recent years, the principle of proximity induction has been transformed into a research tool by researchers and applied to medical and biological research. , whether it is clinical research or basic research, there are applications of this tool.

If the mechanism of tumor apoptosis is really related to CIP, and if the mechanism can be cracked, then it is entirely possible to use K factor to activate the apoptosis program of cancer cells through CIP, and finally kill the cancer cells. In this way, doctors can find a way It is completely feasible to develop new anti-tumor drugs based on this method of killing cancer cells.

The main reason why cancer cells can grow without restriction is that their internal apoptosis program is blocked and in a state of disuse.

It is likely that some factor binds to the promoter of the apoptosis gene in a truncated manner, causing the promoter factor to be unable to bind to its original target. This inhibits their expression through the epigenetic mechanism and shields the apoptosis mechanism.

According to this core biological theory: Cell regulation usually involves the induction mechanism of two different proteins approaching each other. Since there is a certain factor that binds to the promoter, is it possible to treat others in their own way, or to cut off the Hu? In this way, a protein factor is designed to bind to the truncation factor in advance, thereby preventing it from binding to the promoter, and then all these tumor cells will commit suicide.

Yang Ping boldly hypothesized that the cost of conducting experiments in the system space laboratory is extremely low anyway, and the two most important costs - trial and error cost and time cost, are very low here.

Yang Ping decided to follow this idea to study the mechanism of tumor cell apoptosis. It is precisely because his project is currently at a tense moment, whether it is a system space laboratory or a real laboratory, he needs to devote himself to research.

Therefore, Yang Ping has no interest in the European Spine Surgery Academic Association now. Those things are no longer in the same dimension as his own research.

PS: Yesterday around 12 noon, an old man suffered a heart attack at Tianhe Airport in Wuhan, Hubei Province. Eduard Quintana, a cardiac surgeon from Spain, performed first aid and the old man was saved. This made news. The Spanish doctor Eduard Quintana has been studying at the Cardiac and Vascular Surgery Department of Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology for the past month. The content of his study is Professor Wei Xiang's new technology - minimally invasive rotational resection surgery for hypertrophic obstructive cardiomyopathy. Yesterday happened to be the day when he returned to China after studying. Minimally invasive rotational resection surgery for hypertrophic obstructive cardiomyopathy - this is a new technology that has been written before in this article. The original author, Professor Wei Xiang, has also introduced it before. I pay tribute to Professor Wei! Pay tribute to Dr. Eduard Quintana who saved lives!

All the medical skills in this article are not random fabrications. Most of them are completely true. A few are the expression of some scientific research results. It cannot be ruled out that my limited understanding ability may cause errors in the presentation, but this possibility is very rare. When I have time in the future, I will write a single chapter to popularize the black technology of modern medicine. The reason why it is a black technology is because many people don’t know about it.

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