godfather of surgery

The anesthesiologist's dose of medicine was indeed too high, and the patient had to wait for three hours to wake up.

When the patient was sent to the ward, his wife was so excited that she kept crossing herself on her chest when she heard that the operation was successful.

Because before, the patient's wife heard that the operation was very difficult and that one eyeball might need to be sacrificed for the operation. The patient's wife was very scared. No other hospital in the United States was sure about an operation that even Mayo Clinic was not sure about.

Later, Johannesson said that he would invite a Chinese doctor who he thought was an outstanding surgeon to perform the surgery. The patient's wife was even more uneasy. In her opinion, the United States is the country with the most advanced medical skills in the world, but since Johannessen made such an arrangement, he must have Logically, both the patient and his wife agreed to Johanneson's arrangement.

After the patient went in and waited for so long before coming out, the patient's wife was naturally very worried. When she saw that the patient was brought out alive with both eyeballs intact, the patient's wife finally felt relieved.

In the doctor's office, Mayo doctors surrounded Yang Ping.

In fact, it is very simple to conquer these proud Mayo men. It only requires an operation that is beyond their reach.

They rushed to ask questions, hoping to understand all the details of the operation, and also wanted to know how Yang Ping developed such superb surgical techniques.

"Professor Yang, how many intracranial tumor surgeries have you performed? Are there tens of thousands?"

"Aren't you afraid that you won't be able to replant your eyeballs after they are removed?"

"The ophthalmic arteries are so small, why did you anastomose them so quickly?"

"You can perform intracranial tumors and eye surgeries. How do you separate the specialties?"

"I heard that your orthopedics and neurosurgery are the same specialty?"

“Are ophthalmology, orthopedics, and neurosurgery also the same specialty?”

"Sorry, Professor Yang——"

There were so many questions, some of them very strange, and Yang Ping didn't know how to answer them. Johannesson had no choice but to wave his hands: "Don't crowd around, let Professor Yang rest."

"Professor Yang, you have been operating with your arms hanging in the air. It's hard for me to imagine how you did it. Can your arms keep doing this? Aren't they tired and trembling?" Ming Ge, a muscular doctor, finally got a chance.

"You can understand that my arms hanging in the air are the same as your elbows supporting." Yang Ping replied.

The muscular man still didn't understand: "I can't understand it. Doing delicate operations with your arms hanging in the air for a long time. I always thought I could never do it."

"No, it's just a matter of practice makes perfect, like-"

Yang Ping picked up the pencil and paper on the desk next to him. He held the tail end of the pencil, and then used the tip of the pencil to draw. This extreme holding of the pen would make it impossible to write finely because the pencil was too long.

But Yang Ping's pencil tip was very stable and light on the paper, and he quickly drew a picture.

"That's it, practice makes perfect!" Yang Ping dropped the pencil.

Yang Ping's casual performance immediately aroused a burst of admiration. Ming Ge also picked up a pencil and tried to draw using Yang Ping's method. Not to mention drawing, even if he wrote a few simple words, he couldn't control it well at all. The trajectory of the pen tip is crooked and zigzag.

"Professor Yang, can you take the time to visit our eye transplant experiment?"

Ophthalmologist Krause enthusiastically invited Yang Ping to visit their eye transplantation animal experimental project. This research is currently being conducted in the laboratory of Mayo School of Medicine, which is a joint research project between Mayo and Bascom Palmer Eye Institute.

So far, eye transplantation is still in the animal experimental stage around the world and has not yet entered clinical application.

Attempts at animal eye transplantation began in the 19th century and have been in full swing since then, but have stalled and no substantial breakthrough has been made.

In 1977, a team from the National Eye Institute in the United States concluded after careful research: Whole eyeball transplantation cannot be successful!Because there are three insurmountable mountains - immune rejection, lack of neurological function and insufficient blood supply.

Of course, that is just an outdated judgment. Before the moon landing, many people judged that the moon landing was impossible to achieve, but in the end, scientists did not go through many difficulties to realize the dream of landing on the moon.

Immune rejection is a problem faced by all allogeneic organ transplants. With the development of immunosuppressive drugs, this problem can be solved. Since kidney transplantation, liver transplantation, lung transplantation and heart transplantation can all solve the problem of immune rejection, eye transplantation can certainly also solve the problem. Can be solved.

Lack of nerve function is the biggest problem. Once a nerve is broken, unlike other tissues that can be repaired to a certain extent at the break, a broken nerve cannot be repaired. It must rely on new axons to crawl back to the target. Get functionality.

In this regard, these doctors have made some breakthroughs. They have found two special genes in mouse retinal ganglion cells. These two genes will affect the survival time of optic ganglion cells in vitro and the growth distance after repair. So they Gene editing technology was used to delete these two special genes in the retinal ganglion cells of mice. After deleting these two genes, the growth ability of the mouse's optic nerve increased by 10%, allowing longer survival and longer distances. Axon growth.

The last problem, insufficient blood supply, is entirely the result of the level of surgical technology. Replantation of amputated limbs in infants can be successful, so the anastomosis of the ophthalmic artery can theoretically achieve high-quality anastomosis, so this problem can completely rely on superb imaging techniques. Microsurgery techniques are used to solve the problem.

However, the experimental model of the Mayo ophthalmology team uses mice. The ophthalmic artery of mice is much smaller than that of humans. Without extremely advanced vascular anastomosis skills under a microscope, it is indeed easy to cause the experiment to fail.

The problem of insufficient blood supply is currently the main obstacle for the Mayo ophthalmology team. They have tried many times but failed to obtain a high-quality replantation model.

After seeing Yang Ping's superb microsurgery, Klaus felt that with Yang Ping's help, they would be able to solve the problem of insufficient blood supply.

So these three major problems have all been solved.

Klaus briefly introduced his topic. As soon as he heard about "special genes", Yang Ping was very interested in this topic.

The current bottleneck of Yang Ping's own project is "genes that guide the construction of three-dimensional space in cells." He speculates that there must be some special genes in stem cells, which under certain conditions can not only guide stem cells to differentiate, but also guide cells to construct three-dimensional space.

The gene that guides the construction of three-dimensional space in cells was named "gene that guides the construction of three-dimensional space in cells" by Yang Ping.

Mouse retinal ganglion cells are very easy to die after being isolated from the body, and even the few surviving axons cannot grow long distances, which makes eyeball transplantation so difficult.

Mayo ophthalmologists explored the reasons behind it through genetic decoding, and they seemed to be on the right track. They found two special genes.These two special genes were like a lock, locking the viability of retinal ganglion cells, so they tried to delete these two genes. A miracle happened. After deleting the two genes, the retinal ganglion cells of mice became Like opening a lock, it significantly improves their ability to survive and grow.

However, there may be more than just these two special genes. Ophthalmologists still need to continue to work hard and continue to search for special genes until they can completely decipher the mystery.

This idea coincides with Yang Ping's. Yang Ping would like to know how they search for these two special genes, and maybe they can get some inspiration.

Clinicians take clinical problems as their starting point and retrogradely search for the genetic code behind the problem. There are very few such experiments and everyone has little experience, so Yang Ping hopes to gain some experience through the experiments of his peers.

Yang Ping readily agreed to Klaus's invitation to visit the laboratory at Mayo Medical College. Mayo Medical School and Mayo Hospital are in the same town of Rochester, and they are not too far apart, so they won't waste any time.

Yang Ping planned to return to China the next day, so time was very tight. Without much stop, he followed Klaus to visit the animal experiment of eye transplantation.

After Klaus took Yang Ping to visit the entire laboratory, Klaus made no secret of his request:
"Dear Professor Yang, we need your help. If you can help us anastomose the ophthalmic artery, the mouse's eyeballs will definitely receive sufficient blood supply, and the probability of success of the experiment will increase exponentially."

The ophthalmic artery of mice is very small. No matter how the anastomosis was performed in Krause's previous experiments, it would cause varying degrees of stenosis of the blood vessels, either causing blockage and failure, or seriously affecting the blood supply.

Yang Ping said while visiting: "I need to know the detailed information of your experiment so that I know how to help you. For example, whether the problem of blood supply is really only affected by the quality of the vascular anastomosis."

Kraus told Yang Ping: "After the retinal ganglion cells are isolated from the body, they will die quickly even if they receive blood supply. This is an obstacle that prevents us from carrying out allogeneic transplantation."

"Ten years ago, we discovered a strange phenomenon. This strange phenomenon started with the BAX gene. The BAX gene is a gene that coordinates cell death. They found that mice without the BAK gene, after their optic nerves were cut off, lost their ability within a few years. No retinal ganglion cells were lost, but in mice with the BAK gene, all retinal ganglion cells died within three weeks if the optic nerve was cut."

"So we began to study how gene expression affects the survival of nerve cells. We know that the BAK gene is only one of the influencing factors. We need to work hard to find other genes, and then develop drugs to block the expression of some genes, which can make retinal nerve cells Ganglion cells survive well outside the body."

"Surviving is not enough, we must allow the axons of the surviving retinal ganglion cells to grow, long distances, all the way to the visual center of the brain. Fortunately, we have achieved some results and can use drugs to promote neural growth. Axonal growth.”

"Now if high-quality vascular anastomoses can be obtained, I think the experiment will be successful."

Kraus was confident. He attributed the poor results of previous experiments to the poor quality of the ophthalmic artery anastomosis.

In order to get Yang Ping to agree to help with the experiment, Klaus ordered people to pull out all the experimental materials, and some paper materials were also taken out from the experimental archives.

Yang Ping read the information carefully, and when he encountered something he didn't understand, he asked Klaus clearly.

"Professor Yang, can you stay a few more days and help us make several high-quality transplant models?" Klaus asked again after Yang Ping read the information.

Yang Ping shook his head: "I have to rush back to China tomorrow. I can't stay here for a long time. There are still many surgeries waiting for me."

Klaus was very disappointed. He still wanted to fight for it. After all, the opportunity was rare and it would be difficult to have such an opportunity in the future. He said, "Professor Yang, we are willing to pay the honorarium."

Yang Ping waved his hand: "There is no need for the reward. I didn't say I wouldn't help you."

"You want to stay?" Klaus said in surprise.

Yang Ping shook his head: "I have to get on the plane tomorrow, but can I help you complete the transplant model today?"

"Today?" Klaus didn't understand what Yang Ping meant.

Yang Ping said: "Making a few models is just a few operations. Let's prepare. I can help you perform ten operations now and make a high-quality model."

"Now?" Klaus still didn't understand.

Yang Ping said: "I can make a model in half an hour, and it only takes five hours to make a model."

"So fast?" Klaus couldn't believe it.

Yang Ping could use this time to learn more about how they searched for special genes, which would be of great reference value to him.
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In Mayo's Department of Neurosurgery, Johannessen led the crowd to apply to Mayo's senior management and decided to invite Yang Ping to serve as Mayo's specially appointed expert.

Mayo had not had this position before, and the dean was hesitant about the matter. Although Johnson strongly recommended it, it had never done so before by inviting Chinese doctors to serve as specially appointed experts.

Johannessen knew that in order to convince the dean, he had to come up with something shocking, so he placed the recommendation letter signed by the entire department and the video of the operation on the dean’s desk.

The dean opened the video suspiciously and glanced at Johannesson a few times while watching the video: "Is this a case of which hemisphere of your brain?"

Johanathan nodded.

The dean leaned forward and almost put his eyes close to the computer screen. This guy was so bold that he actually took off one of his eyeballs, using the eye socket as an entrance.

The director no longer knew how to evaluate the entire operation, so he could only nod: "Okay, I have to hold a special meeting."

With the strong recommendation of Johannesson and the entire neurosurgery department, Mayo's president and senior management immediately held a meeting to discuss whether to establish the position of "special expert" for Chinese doctors.

Mayo's top executives are all top experts, both internal medicine and surgical experts, and they feel a little baffled by this matter.

Create a special position for Chinese doctors—distinguished experts?Everyone thought it was ridiculous.

But after seeing the video of the operation, all the experts shut up and unanimously agreed to establish this specialized position.

Moreover, Mayo is willing to pay 300 million U.S. dollars every year to invite Yang Ping to be a visiting expert. Yang Ping only needs to come to Mayo a few times a year to guide surgeries. As for Yang Ping’s surgical qualifications at Mayo, they are not needed at all. Worries will be guaranteed by the Mayo Neurosurgery Department, and the Mayo Hospital will apply to the state medical society.