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QuyenNguyen_2011P-_荧光手术_
I want to talk to you about one of the biggest myths in medicine, and that is the idea that all we need are more medical breakthroughs and then all of our problems will be solved. [00:12]
myths:神话;谬见; breakthroughs:突破;
Our society loves to romanticize the idea of the single, solo inventor who, working late in the lab one night, makes an earthshaking discovery, and voila , overnight everything's changed. [00:24]
romanticize:v.使浪漫化;使传奇化;使更加富有吸引力; solo:n.独奏; adj.独奏的; v.单人攀登; v.单独地; earthshaking:adj.极为重大的;震撼全球的; voila:int.(法)瞧;可不是; overnight:adj.夜间的; v.在夜间; n.(美)前一天的晚上;
That's a very appealing picture, however, it's just not true. [00:39]
appealing:adj.吸引人的; v.呼吁; (appeal的现在分词)
In fact, medicine today is a team sport. [00:44]
And in many ways, it always has been. [00:47]
I'd like to share with you a story about how I've experienced this very dramatically in my own work. [00:51]
dramatically:adv.戏剧地;引人注目地;adv.显著地,剧烈地;
I'm a surgeon, and we surgeons have always had this special relationship with light. [00:58]
surgeons:n.外科医生;(surgeon的复数)
When I make an incision inside a patient 's body, it's dark. [01:05]
incision:n.切口;雕刻,切割;切开; patient:adj.有耐心的,能容忍的;n.病人;患者;
We need to shine light to see what we're doing. [01:09]
And this is why, traditionally , surgeries have always started so early in the morning -- to take advantage of daylight hours. [01:12]
traditionally:adv.传统上;习惯上;传说上; surgeries:n.外科手术(surgery复数); take advantage of:利用; daylight:n.日光;
And if you look at historical pictures of the early operating rooms, they have been on top of buildings. [01:19]
historical:adj.历史的;史学的;基于史实的;
For example, this is the oldest operating room in the Western world, in London, where the operating room is actually on top of a church with a skylight coming in. [01:26]
skylight:n.天窗;
And then this is a picture of one of the most famous hospitals in America. [01:36]
This is Mass General in Boston . [01:41]
Mass:n.块,团; adj.群众的,民众的; v.聚集起来,聚集; Boston:n.波士顿(美国城市);
And do you know where the operating room is? [01:43]
Here it is on the top of the building with plenty of windows to let light in. [01:45]
So nowadays in the operating room, we no longer need to use sunlight . [01:52]
sunlight:n.日光;
And because we no longer need to use sunlight, we have very specialized lights that are made for the operating room. [01:57]
specialized:adj.专业的; v.专门研究(或从事); (specialize的过去式和过去分词)
We have an opportunity to bring in other kinds of lights -- lights that can allow us to see what we currently don't see. [02:04]
currently:adv.当前;一般地;
And this is what I think is the magic of fluorescence . [02:13]
fluorescence:n.荧光;荧光性;
So let me back up a little bit. [02:17]
When we are in medical school, we learn our anatomy from illustrations such as this where everything's color-coded . [02:19]
anatomy:n.解剖;解剖学;剖析;解析; illustrations:n.[印刷]插图;插画(illustration的复数); color-coded:颜色编码;
Nerves are yellow, arteries are red, veins are blue. [02:28]
Nerves:n.神经;神经紧张;勇气;v.鼓足勇气;振作精神;(nerve的第三人称单数和复数) arteries:n.[解剖]动脉(artery的复数);v.给…提供动脉(artery的单数第三人称); veins:n.[解剖]静脉(vein的复数); v.使有脉络;
That's so easy anybody could become a surgeon, right? [02:32]
However, when we have a real patient on the table, this is the same neck dissection -- not so easy to tell the difference between different structures . [02:36]
dissection:n.解剖,切开;解剖体;详细查究; structures:n.结构; v.建造(structure的第三人称单数形式);
We heard over the last couple days what an urgent problem cancer still is in our society, what a pressing need it is for us to not have one person die every minute. [02:46]
urgent:adj.紧急的;急迫的; cancer:n.癌症;恶性肿瘤;
Well if cancer can be caught early, enough such that someone can have their cancer taken out, excised with surgery , [03:01]
excised:离体的;切离的; surgery:n.外科;外科手术;手术室;诊疗室;
I don't care if it has this gene or that gene, or if it has this protein or that protein, it's in the jar. [03:10]
gene:n.基因;遗传基因;遗传因子; protein:n.蛋白质;
It's done, it's out, you're cured of cancer. [03:16]
This is how we excise cancers . [03:19]
cancers:n.癌; (Cancers是cancer的复数)
We do our best, based upon our training and the way the cancer looks and the way it feels and its relationship to other structures and all of our experience, we say, you know what, the cancer's gone. [03:21]
We've made a good job. We've taken it out. [03:33]
That's what the surgeon is saying in the operating room when the patient's on the table. [03:36]
But then we actually don't know that it's all out. [03:40]
We actually have to take samples from the surgical bed, what's left behind in the patient, and then send those bits to the pathology lab. [03:43]
surgical:adj.外科的;外科手术的; pathology:n.病理(学);(比喻)异常状态;
In the meanwhile , the patient's on the operating room table. [03:52]
meanwhile:adv.同时,其间;n.其间,其时;
The nurses, anesthesiologist , the surgeon, all the assistants are waiting around. [03:54]
anesthesiologist:n.麻醉学者(医师);
And we wait. [03:58]
The pathologist takes that sample, freezes it, cuts it, looks in the microscope one by one and then calls back into the room. [04:00]
pathologist:n.病理学家; microscope:n.显微镜; one by one:一个接一个;
And that may be 20 minutes later per piece. [04:07]
So if you've sent three specimens , it's an hour later. [04:09]
specimens:n.[试验]试样,[图情]样本(specimen的复数);
And very often they say, "You know what, points A and B are okay, but point C, you still have some residual cancer there. [04:13]
residual:n.剩余;残渣;adj.剩余的;残留的;
Please go cut that piece out ." [04:20]
piece out:把…串连起来;使完整;
So we go back and we do that again, and again. [04:23]
And this whole process : "Okay you're done. [04:26]
process:v.处理;加工;列队行进;n.过程,进行;方法,adj.经过特殊加工(或处理)的;
We think the entire tumor is out." [04:30]
tumor:n.肿瘤;肿块;赘生物;
But very often several days later, the patient's gone home, we get a phone call: "I'm sorry, once we looked at the final pathology, once we looked at the final specimen, [04:32]
we actually found that there's a couple other spots where the margins are positive . [04:45]
margins:n.边缘; v.给…镶边; (margin的复数) positive:adj.积极的;[数]正的,[医][化学]阳性的;确定的;n.正数;[摄]正片;
There's still cancer in your patient." [04:51]
So now you're faced with telling your patient, first of all , that they may need another surgery, or that they need additional therapy such as radiation or chemotherapy . [04:54]
first of all:adv.首先; additional:adj.附加的,额外的; radiation:n.辐射;放射线;放射疗法; chemotherapy:n.[临床]化学疗法;
So wouldn't it be better if we could really tell, if the surgeon could really tell, whether or not there's still cancer on the surgical field? [05:05]
whether or not:是否…;
I mean, in many ways, the way that we're doing it, we're still operating in the dark. [05:15]
So in 2004, during my surgical residency , [05:22]
residency:n.住处;住院医生实习期;
I had the great fortune to meet Dr. Roger Chen, who went on to win the Nobel Prize for chemistry in 2008. [05:25]
fortune:n.财富;命运;运气;v.给予财富,偶然发生 Roger:n.罗杰;[男名]男子名;int.明白;v.与某人性交; Nobel Prize:n.诺贝尔奖;
Roger and his team were working on a way to detect cancer, and they had a very clever molecule that they had come up with . [05:35]
detect:vt.察觉;发现;探测; molecule:n.[化学]分子;微小颗粒,微粒; come up with:提出;想出;赶上;
The molecule they had developed had three parts. [05:44]
The main part of it is the blue part, polycation, and it's basically very sticky to every tissue in your body. [05:48]
basically:adv.主要地,基本上; sticky:adj.粘的;粘性的; tissue:n.纸巾,手巾纸;(人、动植物细胞的)组织;
So imagine that you make a solution full of this sticky material and inject it into the veins of someone who has cancer, everything's going to get lit up. [05:55]
solution:n.解决方案;溶液;溶解;解答; inject:v.注入;注射;
Nothing will be specific . [06:03]
specific:adj.特殊的,特定的;明确的;详细的;[药]具有特效的;n.特性;细节;特效药;
There's no specificity there. [06:05]
specificity:n.[免疫]特异性;特征;专一性;
So they added two additional components . [06:07]
components:n.部件;组件;成份(component复数);
The first one is a polyanionic segment , which basically acts as a non-stick backing like the back of a sticker . [06:09]
segment:n.段;部分;片;弓形;v.分割;划分; non-stick:adj.东西不粘上的,非粘的; sticker:n.粘贴标签;贴纸;
So when those two are together, the molecule is neutral and nothing gets stuck down. [06:16]
neutral:n.中立国; adj.中立的;
And the two pieces are then linked by something that can only be cut if you have the right molecular scissors -- for example, the kind of protease enzymes that tumors make. [06:21]
molecular:adj.[化学]分子的;由分子组成的; scissors:n.剪刀;v.剪断;删除;(scissor的第三人称单数和复数) protease:n.[生化]蛋白酶; enzymes:n.[生化]酶(enzyme的复数);酶类,酵素; tumors:n.肿瘤(tumor的复数);
So here in this situation, if you make a solution full of this three-part molecule along with the dye , which is shown in green, and you inject it into the vein of someone who has cancer, normal tissue can't cut it. [06:33]
dye:n.染料;染液;v.染;给…染色;
The molecule passes through and gets excreted . [06:48]
excreted:adj.排泄出的;分泌出的;v.排泄;分泌(excrete的过去式和过去分词);
However, in the presence of the tumor, now there are molecular scissors that can break this molecule apart right there at the cleavable site . [06:51]
in the presence of:在…面前;有某人在场; site:n.地点;位置;场所;v.设置;为…选址;
And now, boom , the tumor labels itself and it gets fluorescent . [06:59]
boom:n.繁荣;吊杆;v.激增;繁荣昌盛;轰鸣;轰响;adj.(美)猛涨起来的; labels:n.标签;分类(label的复数形式);v.贴标签于;把…称为(label的三单形式); fluorescent:adj.荧光的;萤光的;发亮的;n.荧光;日光灯;
So here's an example of a nerve that has tumor surrounding it. [07:05]
Can you tell where the tumor is? [07:10]
I couldn't when I was working on this. [07:12]
But here it is. It's fluorescent. [07:15]
Now it's green. [07:17]
See, so every single one in the audience now can tell where the cancer is. [07:19]
We can tell in the operating room, in the field, at a molecular level, where is the cancer and what the surgeon needs to do and how much more work they need to do to cut that out. [07:25]
And the cool thing about fluorescence is that it's not only bright, it actually can shine through tissue. [07:37]
The light that the fluorescence emits can go through tissue. [07:45]
emits:发出;放射;发行(emit的动词单数第三人称形式);
So even if the tumor is not right on the surface, you'll still be able to see it. [07:50]
In this movie, you can see that the tumor is green. [07:56]
There's actually normal muscle on top of it. See that? [08:01]
muscle:n.肌肉;力量;v.加强;使劲搬动;使劲挤出;
And I'm peeling that muscle away. [08:04]
But even before I peel that muscle away, you saw that there was a tumor underneath . [08:06]
underneath:prep.在…的下面;在…的支配下;n.下面;底部;adj.下面的;底层的;
So that's the beauty of having a tumor that's labeled with fluorescent molecules . [08:11]
labeled:adj.有标签的; v.示踪; (label的过去分词和过去式) molecules:n.[化学]分子,微粒;[化学]摩尔(molecule的复数);
That you can, not only see the margins right there on a molecular level, but you can see it even if it's not right on the top -- even if it's beyond your field of view. [08:17]
And this works for metastatic lymph nodes also. [08:27]
metastatic:adj.(癌细胞的)转移性的;变形的;新陈代谢的; lymph:n.[解剖]淋巴,淋巴液;血清; nodes:n.茎节;(根或枝上的)瘤,节,结;节点;(node的复数)
Sentinel lymph node dissection has really changed the way that we manage breast cancer, melanoma . [08:30]
Sentinel:n.哨兵;vt.守卫,放哨; lymph node:n.淋巴结; melanoma:n.[肿瘤]黑素瘤;胎记瘤;
Women used to get really debilitating surgeries to excise all of the axillary lymph nodes. [08:36]
debilitating:adj.使衰弱的;v.使虚弱(debilitate的ing形式); axillary:adj.[植]腋生的;腋窝的;叶腋的;n.[鸟]腋羽;
But when sentinel lymph node came into our treatment protocol , the surgeon basically looks for the single node that is the first draining lymph node of the cancer. [08:43]
treatment:n.治疗;疗法;对待;处理;讨论; protocol:n.协议;草案;礼仪;vt.拟定;vi.拟定; draining:v.排空;(使)流光;放干;喝光;喝干;(drain的现在分词)
And then if that node has cancer, the woman would go on to get the axillary lymph node dissection. [08:55]
So what that means is if the lymph node did not have cancer, the woman would be saved from having unnecessary surgery. [09:02]
But sentinel lymph node, the way that we do it today, is kind of like having a road map just to know where to go. [09:11]
So if you're driving on the freeway and you want to know where's the next gas station , you have a map to tell you that that gas station is down the road . [09:18]
freeway:n.高速公路; gas station:n.(汽车)加油站; down the road:只要沿着这条路;将来;在路上;
It doesn't tell you whether or not the gas station has gas. [09:25]
You have to cut it out , bring it back home, cut it up, look inside and say, "Oh yes, it does have gas." [09:29]
cut it out:停止;省省吧;闭嘴;
So that takes more time. [09:36]
Patients are still on the operating room table. [09:38]
Patients:n.接受治疗者,病人;(patient的复数)
Anesthesiologists , surgeons are waiting around. [09:40]
Anesthesiologists:n.麻醉学者(医师);
That takes time. [09:42]
So with our technology , we can tell right away . [09:44]
technology:n.技术;工艺;术语; right away:立刻;
You see a lot of little, roundish bumps there. [09:47]
roundish:adj.圆圆的; bumps:碰撞(bump的第三人称单数);碰撞(bump的复数);
Some of these are swollen lymph nodes that look a little larger than others. [09:50]
swollen:adj.肿胀的,浮肿的;浮夸的;激动兴奋的;
Who amongst us hasn't had swollen lymph nodes with a cold? [09:55]
amongst:prep.在…之中;在…当中(等于among);
That doesn't mean that there's cancer inside. [09:58]
Well with our technology, the surgeon is able to tell immediately which nodes have cancer. [10:00]
I won't go into this very much, but our technology, besides being able to tag tumor and metastatic lymph nodes with fluorescence, we can also use the same smart three-part molecule to tag gadolinium onto the system so you can do this noninvasively. [10:07]
besides:adv.此外;而且;prep.除…之外; gadolinium:n.钆(专有符号缩写Gd);
The patient has cancer, you want to know if the lymph nodes have cancer even before you go in. [10:24]
Well you can see this on an MRI. [10:30]
So in surgery, it's important to know what to cut out. [10:33]
But equally important is to preserve things that are important for function. [10:38]
preserve:vt.保存;保护;维持;腌;禁猎;n.保护区;禁猎地;加工成的食品;
So it's very important to avoid inadvertent injury . [10:46]
inadvertent:adj.疏忽的;不注意的(副词inadvertently);无意中做的; injury:n.伤害,损害;受伤处;
And what I'm talking about are nerves. [10:49]
Nerves, if they are injured , can cause paralysis , can cause pain. [10:53]
injured:adj.受伤的:委屈的: v.伤害,使受伤: n.伤员; paralysis:n.麻痹;无力;停顿;
In the setting of prostate cancer, up to 60 percent of men after prostate cancer surgery may have urinary incontinence and erectile disfunction . [11:00]
prostate:adj.前列腺的;n.[解剖]前列腺; urinary:n.尿壶;小便池(等于urinal);adj.尿的;泌尿的; incontinence:n.[医]失禁;无节制;不能自制; erectile:adj.勃起的;[昆]可使直立的; disfunction:n.机能不良;官能障碍;功能紊乱;
That's a lot of people to have a lot of problems -- and this is even in so-called nerve-sparing surgery, which means that the surgeon is aware of the problem, and they are trying to avoid the nerves. [11:10]
so-called:adj.所谓的;号称的; nerve-sparing:神经保留;保留性神经;
But you know what, these little nerves are so small, in the context of prostate cancer, that they are actually never seen. [11:23]
context:n.环境;上下文;来龙去脉;
They are traced just by their known anatomical path along vasculature . [11:31]
traced:v.发现;追踪;追究;描绘;记述;(trace的过去分词和过去式) anatomical:adj.解剖的;解剖学的;结构上的; vasculature:n.脉管系统;
And they're known because somebody has decided to study them, which means that we're still learning about where they are. [11:37]
Crazy to think that we're having surgery, we're trying to excise cancer, we don't know where the cancer is. [11:45]
We're trying to preserve nerves; we can't see where they are. [11:51]
So I said, wouldn't it be great if we could find a way to see nerves with fluorescence? [11:54]
And at first this didn't get a lot of support. [12:01]
People said, "We've been doing it this way for all these years. [12:05]
What's the problem? [12:07]
We haven't had that many complications." [12:09]
But I went ahead anyway. [12:12]
And Roger helped me. [12:14]
And he brought his whole team with him. [12:16]
So there's that teamwork thing again. [12:19]
And we eventually discovered molecules that were specifically labeling nerves. [12:23]
eventually:adv.最后,终于; specifically:adv.特别地;明确地; labeling:n.标签;标记;[计]标号;v.贴标签;分类;(label的现在分词)
And when we made a solution of this, tagged with the fluorescence and injected in the body of a mouse, their nerves literally glowed . [12:28]
tagged:adj.标记的;示踪的;加标记的;v.附以签条(tag的过去分词); injected:v.(给…)注射(药物等); (inject的过去分词和过去式) literally:adv.按字面:字面上:确实地: glowed:vi.发热;洋溢;绚丽夺目;n.灼热;色彩鲜艳;兴高采烈;
You can see where they are. [12:37]
Here you're looking at a sciatic nerve of a mouse, and you can see that that big, fat portion you can see very easily. [12:39]
sciatic:adj.坐骨的;坐骨神经的;髋部的; portion:n.部分;(食物的)一份;分担的责任;v.把…分成若干份(或部分);
But in fact, at the tip of that where I'm dissecting now, there's actually very fine arborizations that can't really be seen. [12:46]
tip:n.小窍门,小费;v.给…小费;使倾斜; dissecting:adj.解剖的;v.解剖;仔细检查(dissect的ing形式);
You see what looks like little Medusa heads coming out. [12:54]
Medusa:n.水母;水母体;
We have been able to see nerves for facial expression , for facial movement, for breathing -- every single nerve -- nerves for urinary function around the prostate. [12:58]
facial:adj.面部的,表面的;脸的,面部用的;n.美容,美颜;脸部按摩; expression:n.表现,表示,表达;
We've been able to see every single nerve. [13:08]
When we put these two probes together ... [13:11]
probes:n.探索; v.探查;
So here's a tumor. [13:15]
Do you guys know where the margins of this tumor is? [13:17]
Now you do. [13:20]
What about the nerve that's going into this tumor? [13:23]
That white portion there is easy to see. [13:26]
But what about the part that goes into the tumor? [13:28]
Do you know where it's going? [13:30]
Now you do. [13:32]
Basically, we've come up with a way to stain tissue and color-code the surgical field. [13:34]
stain:v.沾污;败坏;给…着色;n.污点;瑕疵;着色剂;
This was a bit of a breakthrough. [13:40]
I think that it'll change the way that we do surgery. [13:43]
We published our results in the proceedings of the National Academy of Sciences and in Nature Biotechnology . [13:47]
proceedings:n.诉讼;行动(proceeding的复数形式);会议记录;议程; Academy:n.学院;研究院;学会;专科院校; Biotechnology:n.[生物]生物技术;[生物]生物工艺学;
We received commentary in Discover magazine, in The Economist. [13:53]
commentary:n.评论;注释;评注;说明;
And we showed it to a lot of my surgical colleagues . [13:58]
colleagues:n.同事;同行(colleague的复数);
They said, "Wow! [14:01]
I have patients who would benefit from this. [14:03]
I think that this will result in my surgeries with a better outcome and fewer complications." [14:07]
outcome:n.结果,结局;成果;
What needs to happen now is further development of our technology along with development of the instrumentation that allows us to see this sort of fluorescence in the operating room. [14:14]
instrumentation:n.使用仪器;乐器法;仪表化;
The eventual goal is that we'll get this into patients. [14:28]
However, we've discovered that there's actually no straightforward mechanism to develop a molecule for one-time use. [14:33]
straightforward:adj.简单的;坦率的;明确的;径直的;adv.直截了当地;坦率地; mechanism:n.机制;原理,途径;进程;机械装置;技巧; one-time:adj.以前的;古时的;adv.一度(等于onetime);从前;
Understandably , the majority of the medical industry is focused on multiple-use drugs, such as long-term daily medications . [14:42]
Understandably:adv.可理解地; majority:n.大部分:大多数:多数票:成年人: long-term:adj.长期的;从长远来看; medications:n.药;药物;(medication的复数)
We are focused on making this technology better. [14:52]
We're focused on adding drugs, adding growth factors , killing nerves that are causing problems and not the surrounding tissue. [14:55]
factors:n.因素(factor的复数); v.做代理商;
We know that this can be done and we're committed to doing it. [15:05]
committed:adj.坚信的; v.做出错事; (commit的过去分词和过去式)
I'd like to leave you with this final thought. [15:09]
Successful innovation is not a single breakthrough. [15:13]
innovation:n.创新,革新;新方法;
It is not a sprint . [15:18]
sprint:vi.冲刺,全速跑;n.冲刺;短跑;vt.全速奔跑;
It is not an event for the solo runner. [15:21]
Successful innovation is a team sport, it's a relay race. [15:25]
relay:n.接力赛; v.转发(信息、消息等);
It requires one team for the breakthrough and another team to get the breakthrough accepted and adopted . [15:30]
adopted:adj.被收养的;被采用的;v.采用;接受;(adopt的过去式和过去分词);
And this takes the long-term steady courage of the day-in day-out struggle to educate, to persuade and to win acceptance . [15:38]
steady:adj.稳定的; v.使稳定; v.稳定地; n.关系固定的情侣; persuade:v.说服;劝说;使信服;使相信; acceptance:n.验收;接受;认可;承认;
And that is the light that I want to shine on health and medicine today. [15:49]
Thank you very much. [15:53]
(Applause) [15:55]