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

我是一個製程工程師。

But I also have Marfan syndrome.

我知道關於鍋爐和焚化爐的一切，

This is an inherited disorder.

包括像織物過濾器和旋風分離器一樣的東西。

And in 1992, I participated in a genetic study,

但我也患有馬凡氏症候群。

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

它是一個遺傳性疾病。

that my ascending aorta was not in the normal range,

在1992年，

the green line at the bottom.

我參加了一項基因研究，

Everyone in here will be between 3.2-3.6,

我驚恐的發現，如同你從投影片上所看到的，

and I was already up at 4.4.

我的升主動脈不在底下那條綠線標示出的

And as you can see, my aorta dilated progressively,

正常範圍之內。

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

在座的每位的升主動脈都會在 3.2 到 3.6 公分之內，

The surgery on offer was pretty gruesome.

而我的是 4.4.

Anesthetize you, open your chest,

如你所見，

put you on an artificial heart and lung machine,

我的主動脈不斷的擴大，

drop your body temperature to about 18 centigrade,

而我也離需要手術的階段

stop your heart, cut the aorta out,

越來越近。

replace it with a plastic valve and a plastic aorta.

這項手術有些可怕 -

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

麻醉你後將你的胸腔打開，

Normally, warfarin.

將你接上人工心肺儀器，

The thought of the surgery was not attractive.

將你的身體溫度降到大約攝氏18度左右，

The thought of the warfarin was really quite frightening.

停止你的心臟跳動，切除大動脈，

So I said to myself,

替換上人工瓣膜和人工大動脈，

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

最後，最重要的，

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

你將一輩子需要使用華法令阻凝劑的

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

抗凝療法。

The project aim is really quite simple.

手術這件事情聽起來不是很吸引人，

The only real problem with the ascending aorta

而需要使用華法令阻凝劑的這個想法

in people with Marfan syndrome

讓我感到非常害怕。

is that it lacks some tensile strength.

所以我告訴自己，我是一名搞研究開發的工程師，

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

這只是一個像水管的問題，

and it would remain stable and operate quite happily.

我可以自己搞定，我可以改變它。

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

於是我開始嘗試

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

改變對於動脈擴張的

In concept, though not in execution.

全部療程。

The great advantage of an external support, for me,

我的目標非常簡單。

was that I could retain all of my own bits,

有著馬凡氏癥候群的人的升大動脈的

all of my own endothelium and valves,

唯一真正地問題

and not need any anticoagulation therapy.

就是它缺乏張力。

So, where do we start?

所以有一個可能便是

This is a sagittal slice through me.

將血管從外面包住，

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

它便可以保持穩定並正常的運作。

that's the left ventricle,

如果你的高壓水管，

pushing blood out through the aortic valve.

或你的高壓液壓管路有一點點的膨脹，

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

你只需要用一些膠帶纏繞住它的外面。

Up into the ascending aorta.

這個原理非常簡單，

And it's that part, the ascending aorta,

但在執行上卻恰恰相反。

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

這種外部的支撐對我有一個很大的好處，

We started by organizing image acquisition

那就是我可以保持我自己身體的部份，

from magnetic resonance and CT imaging machines,

我自己所有的內皮和瓣膜，

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

以及不需要任何的抗凝療法。

This is a model of my aorta.

那我們從哪裡開始呢？

I've got a real one in my pocket,

這是我的一個矢狀切片，

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

你可以看到在中間

(Laughter)

有個很小的結構在往外擠壓。

You can see it's quite a complex structure.

那是左心室

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

在通過主動脈辦 -

which contains the aortic valve.

你可以看到主動脈瓣的兩個瓣膜在工作 -

It then comes back into a round form,

往升大動脈中壓血。

and then tapers and curves off.

而升大動脈的

It's quite a difficult structure to produce.

擴大和最終的破裂

This is a sort of CAD model of me,

終將致命。

and this is one of the later CAD models.

我們從排列核磁共振

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

和電腦斷層掃描

When we produced that model,

得到的照片開始，

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

來為患者的大動脈

using a rapid prototyping technique, another engineering technique.

建造一個模型。

We then used that former

這是我的大動脈的模型。

to manufacture a perfectly bespoke porous textile mesh,

我的口袋裏面有一個真的模型，

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

如果有人想看並把玩一下。

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

你可以看到，它的構造有些複雜。

Every patient we do has an absolutely bespoke implant.

它下方一個奇怪的三葉形的形狀

Once you've made it, the installation is quite easy.

包括了主動脈瓣。

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

接著它慢慢變成了圓形，

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

並逐漸變細。

he put the second one in.

所以的確是個滿難建造的

Happy, away I went.

一個架構

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

這個，就像我說的，是我的電腦輔助設計出來的模型，

So the surgical implantation was actually the easiest part.

而這個是最新的模型之一。

If you compare our new treatment to the existing alternative,

爲了建造更好的模型，

the composite aortic root graft,

我們經歷了很多反複的步驟。

there are one or two startling comparisons

當我們建造這個模型的時候，

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

正如你所見，

Two hours to install one of our devices,

我們利用快速成型技術，

compared to 6 hours for the existing treatment.

一種工程技術，

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

把它變成了一個實體塑料模型。

and it requires a total body cooling.

我們接著用先前的模型

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

來生產一個完全預製的

He opens you up,

以之前的模型為形狀

he accesses the aorta while your heart is beating,

完全適合大動脈的

all at the right temperature.

多孔紡織網。

No breaking into your circulatory system.

所以這是完完全全的

So it really is great.

最好的個體化醫療。

But for me, absolutely the best point is,

我們的每一個病患

there is no anticoagulation therapy required.

都有一個完全為他們訂製的植入物。

I don't take any drugs at all,

當你建造了它后，裝上它還算簡單。

other than recreational ones that I would choose to take.

John Pepper，上帝保佑他，

(Laughter)

他是一位心胸外科的教授 -

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

在他的生涯中，之前從未做過這個手術。

it is a serious compromise to your quality of life,

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。

and even worse, it inevitably foreshortens your life.

然後我開心的離開了。

Likewise, if you have the artificial valve option,

躺在手術臺上四個半小時，然後一切都搞定了。

you're committed to antibiotic therapy

所以手術植入其實是最簡單的部份。

whenever you have any intrusive medical treatment,

如果你將我們的新療法和現有的

even trips to the dentist require that you take antibiotics,

所謂的複合主動脈根部移植物來做比較，

in case you get an internal infection on the valve.

有兩個讓人吃驚的發現。

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

我待會會很清楚的展現在各位面前。

my artery is fixed.

裝我們的裝置需要花兩個小時，

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

而現有的治療卻需要

Back to the theme of the presentation, multidisciplinary research,

六個小時。

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

現有的治療，就像我所提到的，

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

需要人工心肺儀器，

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

並需要完全的冷卻人體。

This is a list of the core team,

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。

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

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

medicine and engineering,

揀出大動脈。

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

你的血液循環系統也不需要被打斷。

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

所以它真的很好。

But everyone else had to contribute one way or another.

但對我來說，最好的一點

Raad Mohiaddin, a medical radiologist.

是不需要任何的抗凝療法。

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

除了我選擇吃的養生藥物之外，

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

我不需要吃任何的藥。

had to write a bespoke piece of CAD code

（笑聲）

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

事實上，如果你和長期使用華法令抗凝療法的人交談，

There are some barriers to this, though, there are some problems.

你會發現華法令對生活的品質有著嚴重的損害。

Jargon is a big one.

更糟的是，

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

它不可避免的會縮短你的生命。

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

同樣的，如果你選擇了人造瓣膜，

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

當你有任何的侵犯性的治療時，

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

你都需要使用抗生素療程。

Taking the jargon out was very important

連去牙醫那你都需要吃抗生素

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

來預防任何瓣膜的內部感染。

when a particular phrase was used.

而我，完全不需要這些，所以我是完全自由的。

Our disciplinary conventions were funny as well.

我的大動脈被治好了，我不需要擔心它，

We took a lot of horizontal slice images through me,

這對我來說是一個重生。

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

重新回到我演講的主題：

And the very first CAD model we made,

在跨越多個領域的研究中，

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

一個習慣和鍋爐工作的製程工程師

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

是如何建造一個完全改變他自己生命的

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

醫療儀器？

we always look down on plans,

一個跨領域的團隊是這個問題的答案。

plans of houses, or streets, or maps.

這是中心團隊的人員列表。

In the medical world, they look up at plans.

就像你所看到的，

So the horizontal images were all in inversion.

它不僅僅包括了兩個大的領域，

So, one needs to be careful with disciplinary conventions.

醫學和工程學，

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

也包括了這兩種領域中的

Institutional barriers were another serious headache in the project.

各種專業人員。

The Brompton Hospital was taken over

John Pepper 是

by the Imperial College School of Medicine.

為我動手術的那位心臟外科醫生。

And there are some seriously bad relationship problems

但名單中的每一位都做出了一定的貢獻。

between the two organizations.

Raad Mohiaddin 是醫療放射專家：

I was working with the Imperial and the Brompton,

我們需要高質量的圖像

and this generated some serious problems for the project.

來建造電腦輔助冠狀動脈模型。

Really, problems that shouldn't exist.

Warren Thornton 仍然在為我們建造所有的模型。

Research & Ethics Committee.

他需要為每一個預訂的模型

If you want to do anything new in surgery,

從一個相當困難的數據輸入資料中

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

寫一個特殊的電腦輔助模型編碼。

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

但這仍然有些障礙以及問題。

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

行業術語是很大的一個。

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

我認為在座的每一位應該都不知道

we also had professional jealousies.

前面這四個行業術語。

There were people on the Research & Ethics committee

在座的工程師們

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

可以認出快速成型和電腦輔助設計。

Because he is so successful.

在座的醫療行業的，如果有的話，可以認出前兩個。

And they made extra problems for us.

但在座的沒有人

Bureaucratic problems.

可以明白全部的四個詞。

Ultimately, when you have a new treatment,

將行業術語剔除

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

對確保團隊中的每個人

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

在一個詞被使用時

You have an equivalent in Poland, no doubt.

能夠明白它的意思，非常的重要。

And we had to get past the NICE problem.

各個行業習慣的不同也非常有趣。

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

透過我，我們得到了很多橫切圖像，

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

製造這些切片圖像並用他們來建造電腦輔助設計模型。

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

我們建造的第一個模型，

Funding barriers, another big area to be concerned with.

外科醫生在把玩了這個塑料模型後

A big problem with understanding one of those perspectives.

不太能夠完全理解。

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

然後我們意識到它是真的大動脈的

that fund this kind of stuff,

翻版。

we essentially gave them an engineering proposal.

它是一個鏡像圖像

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

因為在現實中我們總是從上面的角度往下看，

it must be rubbish, they binned it.

房子或者是街道的規劃圖或地圖。

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

在醫學的世界中，他們是由下往上看規劃圖，

Most R&D is going to be institutionally funded,

所以橫切圖像是完全相反的。

by the Polish Academy of Sciences

所以我們也要注意行業的習慣。

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

每個人都需要明白

And you need to get past those people.

什麽是假設的，什麽是沒有被假設的。

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

制度性障礙

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

是項目中另一個讓人頭痛的問題。

Not in the medical world.

布朗普頓醫院在被

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

帝國學院的醫學院接管後，

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

兩個機構之間存在著

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

非常嚴重的問題。

(Laughter)

我在和帝國和布朗普頓合作的時候，

Which it probably is.

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，

(Laughter)

一些其實根本就不應該存在的問題。

I've coined the phrase "obstructive conservatism."

研究和倫理委員會： 如果你想在手術中做些新的嘗試，

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

你必須先從當地的研究和倫理委員會處獲得許可證。

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

我確定波蘭也是這樣的。

They don't want to change.

那將會有一些類似的程序

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

來許可新的類型的手術。

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

我們不僅僅有著和這有關的官僚問題，

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

我們還遭到了一些同行的嫉妒。

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

有些在研究和倫理委員會的人

We've actually got 30 patients.

並不希望 John Pepper 再次成功，

At seven and a half years,

因為他已經是如此的有成就。

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

所以他們對我們造成了很多多餘的問題，

and we haven't had a single problem.

官僚問題：

And still, there are people in the UK saying,

當你有一個新的療程的時候，

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

最終你必須給國內的每個醫院寄出一個

It really is a problem.

指導說明。

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

在英國，我們有國家衛生醫療質量標準署，簡稱NICE。

amongst medics, doctors, surgeons, at some point.

你們在波蘭毫無疑問的也有類似的機構。

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

我們必須通過NICE這一關。

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

我們現在在網路上有一個很好的臨床指導書。

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

所以每個有興趣的醫院

Egos, of course, again a huge problem.

都可以上網讀這份報告，

If you work in a multidisciplinary team,

和我們聯繫，然後自己可以開始進行這項手術。

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

資金障礙：

you've got to express support for them.

資金來源是另一個需要考量的大問題。

Tom Treasure, professor of cardiothoracic surgery.

另一個個跟理解這個願景的情況的大問題是

Incredible guy.

當我們第一次跟英國提供這種資金援助的

Dead easy to give him respect.

大的慈善機構之一接洽的時候，

Him giving me respect? Slightly different.

從他們的角度看，根本是一個工程提案。

(Laughter)

他們看不懂； 因為他們是醫生，他們僅次於上帝。

That's all the bad news.

所以它肯定是垃圾。 於是他們將它扔了。

The good news is, the benefits are stonkingly huge.

所以最後，我放棄了。