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  • [♪ INTRO]

  • Modern medicine is pretty incredible.

  • But even in a world where open-heart surgery and brain-scanning headsets

  • sound almost mundane, some medical advances do truly seem

  • like science fiction.

  • So here are five recent developments that sound like they're

  • straight out of the future, but are already around today.

  • Robots and surgeons go way backin fact, robots have been

  • in operating rooms since the late 1980s, helping out

  • with all types of routine procedures.

  • But in February 2020, surgeons in the Netherlands kicked things up a notch.

  • They used a very precise robotic arm with teeny tiny tools

  • on the end to operate on blood vessels just a few times

  • the size of a human hair.

  • It was the first human trial of robot-assisted supermicrosurgery,

  • which is surgery on vessels smaller than eight-tenths of a millimeter.

  • Surgeries at these scales are really tricky for humans,

  • because our hands do shakemaybe just a little bit,

  • but at these scales, every millimeter counts.

  • So only highly-trained surgeons are capable of doing these procedures.

  • One of these very precise surgeries, called

  • a lymphatico-venous anastomosis, or an LVA, is a treatment

  • for breast cancer patients whose lymph isn't draining properly.

  • Lymph is a fluid that transports white blood cells

  • and other nutrients around the bodyand when it doesn't

  • drain properly, it can cause swelling and pain.

  • But with surgery, tiny lymph vessels can be connected

  • to blood vessels to give the lymph another way out.

  • This surgery is at the very limit of human capabilities,

  • but the team of surgeons and roboticists in the Netherland thought

  • they might just be able to make the procedure easier and safer.

  • They devised a robot called MUSA, which mimics a surgeon.

  • It has two arms that go over the patient, with tiny surgical tools

  • on the ends instead of hands.

  • To manipulate the robot, a surgeon looks at the patient

  • through a microscope and moves a set of controllers

  • as if they were operating directly on a person.

  • But it's the robot's tiny tools that are actually

  • performing the surgery.

  • The robot mimics the surgeon's movements exactly,

  • except it filters out tremors.

  • It also scales those movements down, since the surgeon is looking

  • at the patient through a microscope and making bigger motions.

  • Out of 20 surgeries, MUSA assisted in eight, and all of them

  • were a success.

  • Unlike a human, the robot didn't twitch or get tired,

  • and it could hold an awkward position forever if it had to.

  • This success is really exciting, because a robot like MUSA

  • could make this type of complex surgery possible

  • for more surgeonswhich means more people could get

  • the treatment they need.

  • The reason a lot of people who are paralyzed can't move their limbs

  • is because the nerves that should be taking signals from the brain

  • to the rest of the body aren't working the way they should.

  • And for many people with this kind of nerve damage,

  • the condition is permanent.

  • But in a case study published in 2019 in the journal

  • The Lancet Neurology, a team of researchers in France found

  • a creative way for a man who was paralyzed below the neck

  • to control his limbs again.

  • Their idea was to bypass the nerves completelyby recording messages

  • straight from the brain and sending them to a machine

  • that could carry out its orders.

  • The solution combined incredible advances in both

  • brain scanning and robotics.

  • First, the team inserted two small implants into the patient's brain

  • to measure activity in the areas that control movement.

  • The implants were hooked up wirelessly to a computer system,

  • which decoded the brain signals and translated them

  • into instructions for a virtual avatar or a full-body exosuit.

  • But it was not as straightforward as it sounds.

  • See, scientists know which regions of the brain broadly

  • control movement, but for this contraption to work, the system

  • needed to match up an exact pattern of active brain cells

  • with a specific movement.

  • And that's not exactly easy. Like, what does [this] look like

  • on a brain scan, compared to, like, [this]?

  • The team started by having the patient think about a specific action

  • like rotating his wrist or moving a wheelchair forward.

  • The computerwhich was hooked up wirelessly to his brain

  • would record the signals that thought created.

  • Then, over the course of two years, the computer created a model

  • of the patient's brainbasically like a dictionary that matched

  • brain patterns to movements.

  • In a way, he was both training the computer to understand

  • his brain signals, and training himself to think in a structured

  • and focused way that a computer would understand.

  • And in the end, the patient was able to use the system

  • to do all sorts of things!

  • He drove a wheelchair and made virtual hands do things like

  • turn over or touch a target.

  • He also gained the ability to start and stop an exoskeleton.

  • It was attached to a harness mounted on the ceiling, so while

  • he wasn't completely independent, he could essentially walk.

  • Now, this wasn't the first time scientists created

  • an interface between a brain and a computer, but the small surgery

  • it required was much less invasive than other methods.

  • And while it's still a long ways from widespread use, it's a big step

  • toward developing a way for paralyzed people to control robotic limbs

  • with nothing but their thoughts.

  • In March 2020, doctors in Oregon announced that they had used

  • the DNA-editing tool CRISPR-Cas9 in a living person

  • for the first time.

  • Their goal was to treat a rare genetic condition that causes blindness by

  • justfixing the faulty code in the DNA.

  • Which is actually possible because Cas9 is an enzyme

  • that can cut apart molecules, and it allows researchers

  • to snip a strand of DNA at a precise location

  • and replace faulty code with new instructions.

  • This technology itself isn't that new.

  • Scientists have been using it to edit genes in bacteria,

  • fruit flies, plants, and other organisms since 2013.

  • And in a different study, also published in February of 2020,

  • doctors actually edited the white blood cells of three people

  • with cancerbut they did the editing outside the patients' bodies.

  • That same month, though, the team in Oregon took gene-editing

  • a step further when they announced that they had used it directly

  • in the human body to edit the genes of living cells

  • although when we filmed this video,

  • they didn't yet have their results.

  • This clinical trial involved a patient with a rare inherited

  • eye disease called Leber congenital amaurosis, which affects

  • the cells of the retina and causes blindness.

  • And this disease can be caused by a mistake in a gene called CEP290 -

  • that's what researchers wanted to fix.

  • In the trial, doctors used a needle to inject a few drops

  • of a solution containing the CRISPR-Cas9 system into the space

  • just behind the retina.

  • The idea was that CRISPR-Cas9 would find the cells of the retina

  • and snip away the mutation, leaving behind a functional gene.

  • If it works, it should be a permanent cure.

  • And the retina is a good place to test out gene editing in humans,

  • because it's isolated from the rest of the bodyso changes made

  • on one eye won't affect any other part of the body.

  • After all, there are a lot of valid reasons to be concerned about

  • doing gene-editing in humansbut this is a pretty safe place to start.

  • And if the procedure does cure the patient's blindness,

  • it's not just good news for people with this rare disease;

  • it could open up the possibility for other gene therapy treatments as well.

  • These days, there's not much you can do if you scrape up a knee

  • or get any injury that breaks the skin.

  • It's just got to heal, and it takes as long as it takes.

  • But in 2018, researchers at the University of Wisconsin-Madison

  • reported that they had built a device that healed injuries

  • in rats four times faster than they heal on their own.

  • The device itself is really simple: It's basically

  • a little electric bracelet that delivers gentle electric pulses

  • to the site of an injury.

  • Now electricity naturally plays a role in helping wounds heal.

  • Scientists have known since the 1800s that anytime you get an injury,

  • your body naturally creates an electric field around it.

  • And in more recent studies, researchers have even watched cells

  • move around and restructure themselves in response

  • to an electric field.

  • You know. As they do.

  • They still don't know exactly how the cells are responding

  • to that electricity, but electricity seems to promote the growth

  • of new cells, which is what it takes to close a wound.

  • So this device was designed to speed up healing

  • by providing additional electricity to the injured region.

  • And in rats, the results were kind of incredible.

  • An injury that normally took almost two weeks to heal closed up

  • in three days.

  • Eventually, researchers hope to test something like this

  • on human skin.

  • And in the meantime, they've found evidence that this technology

  • may even have an extra perkit might reverse baldness.

  • In a separate experiment, they applied a patch with

  • the same technology to mice with a genetic condition keeping them

  • from producing certain chemicals that make hair grow.

  • So the mice are naturally hairless, but after just nine days,

  • they'd grown hair under the electric patch.

  • Researchers believe the patch works by stimulating the cells in

  • the area so they release those chemicals that tell hair to grow.

  • Now, you may have noticed that your head is not mouse skin.

  • But if tests in humans go well, products with this technology

  • could eventually hit the market, but in the meantime

  • in case you need me to say itdon't try this at home.

  • Everywhere around the world, there are more people

  • who need organs than there are donors.

  • Like, right now, there are over 100,000 people in the U.S.

  • waiting for kidneys.

  • And even in a record-setting year like 2019, fewer than

  • a quarter of those people will get them.

  • So lives depend on finding more kidneys.

  • And in 2015, doctors in the U.K. found a new way to put kidneys

  • from deceased donors back in business, using a technique

  • called ex-vivo normothermic perfusion.

  • This technique uses a jolt of nutrients to repair kidneys

  • from deceased donors and make them usable againwhich is not easy.

  • Because, as soon as a person dies, their organs start to deteriorate.

  • Doctors can slow that deterioration by chilling an organ,

  • but even then, kidneys have to be transplanted within a day or two,

  • or they're often too far gone.

  • This new procedure helps by putting new life into kidneys

  • that have passed the usual point of no return.

  • First, the kidney gets removed from the deceased donor and kept cold,

  • just like usual.

  • Then it has to travelsometimes down the hall,

  • other times to a different city.

  • Once it gets where it's going, it goes into a special machine

  • that's kind of like a spabut for kidneys.

  • It pumps warm blood and nutrients through the organ until

  • it's working at peak efficiency.

  • Then it's good to go back to work in the world of the living.

  • What's cool about this procedure is it doesn't just wake

  • the kidney back upit also gives the surgeons a chance

  • to make sure the kidney works on a machine,

  • before it goes into a human.

  • Kidneys that were borderline become healthy enough

  • to use after this little trip to the kidney spa.

  • And, so far, the early results are promising.

  • Initial studies show that the revived kidneys are at least

  • as safe as kidneys typically used for transplants.

  • Other trials are still in progress to make sure it's completely safe,

  • but if things go well, this could save a lot of lives.

  • For now, many of these advances are proofs of concept and still

  • far from being your everyday reality, but they show how quickly

  • science fiction can become science and help us to live

  • longer, healthier lives.

  • Thanks for watching this episode of SciShow!

  • And a special thanks to our patrons on Patreon who make it possible

  • for us to share all this amazing science with you.

  • If you'd like to join our amazing community of patrons,

  • you can find out more at patreon.com/SciShow.

  • [♪ OUTRO]

[♪ INTRO]

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機器人外科醫生和其他4個聽起來像科幻小說的醫學進展。 (Robot Surgeons and 4 Other Medical Advances That Sound Like Sci-Fi)

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    林宜悉 發佈於 2021 年 01 月 14 日
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