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請各位想像一下:你是一名士兵,正在戰場上奔跑,你的腿被子彈射中,撕裂了你的股動脈,現在你血流如注,三分鐘內就會死亡。不幸的是,當軍醫終於來到你身邊時,或許得花五分鐘以上的時間,才能藉由施壓止住這種程度的流血。這不僅是軍隊的大問題,也是與整個醫學界有關的大問題。我們該如何處理傷口?如何藉由適用於人體的方法快速止血?因此過去四年我致力研究的目標就是開發智慧生物材料,使這些材料適用於人體、幫助治療、幫助傷口正常癒合。因此在展開研究前,我們需要仔細研究人體運作的方式。
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I want you guys to imagine that you're a soldier running through the battlefield. Now, you're shot in the leg with a bullet, which severs your femoral artery. Now, this bleed is extremely traumatic and can kill you in less than three minutes. Unfortunately, by the time that a medicactually gets to you, what the medic has on his or her belt can take five minutes or more, with the application of pressure, to stop that type of bleed. Now, this problem is not only a huge problem for the military, but it's also a huge problem that's epidemic throughout the entire medical field,which is how do we actually look at wounds and how do we stop them quickly in a way that can work with the body? So now, what I've been working on for the last four years is to develop smart biomaterials, which are actually materials that will work with the body, helping it to heal and helping it to allow the wounds to heal normally. So now, before we do this, we have to take a much closer look at actually how does the body work.
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在座各位都知道人體由細胞構成,因此細胞是構成生命的最基本單位,但大多數人對其他部分瞭解不多。事實上你的細胞分佈在纖維、蛋白質和糖構成的複雜網路中,稱之為細胞外基質。細胞外基質事實上是固定細胞的網路結搆,為你的組織提供支撐,也為細胞提供容身處。細胞外基質使細胞瞭解它們的作用、位置以及該如何運作和表現。事實上身體各部位的細胞外基質均不相同,因此皮膚細胞外基質不同於肝細胞外基質,同一個器官不同部位的細胞外基質也會有所不同,因此很難獲得可與所有部位細胞外基質產生反應的產品,這正是我們嘗試的目標。舉例來說,想像一片熱帶雨林,其中包括樹冠層、林下層、地面層,雨林中不同區域孕育著不同的植物和動物。因此就像這樣,細胞外基質在三維空間裡存在驚人的多樣性,此外,細胞外基質負責所有傷口的癒合。因此想像一下,如果割破身體就得重建複雜萬分的細胞外基質,以便使細胞外基質癒合,傷疤事實上是勉強癒合的細胞外基質。
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So now, everybody here knows that the body is made up of cells. So the cell is the most basic unit of life. But not many people know what else. But it actually turns out that your cells sit in this mesh of complicated fibers, proteins and sugars known as the extracellular matrix. So now, the ECM is actually this mesh that holds the cells in place, provides structure for your tissues, but it also gives the cells a home. It allows them to feel what they're doing, where they are, and tells them how to act and how to behave. And it actually turns out that the extracellular matrix is different from every single part of the body. So the ECM in my skin is different than the ECM in my liver, and the ECM in different parts of the same organ actually vary, so it's very difficult to be able to have a product that will react to the local extracellular matrix, which is exactly what we're trying to do. So now, for example, think of the rainforest. You have the canopy, you have the understory, and you have the forest floor. Now, all of these parts of the forest are made up of different plants, and different animals call them home. So just like that, the extracellular matrix is incredibly diverse in three dimensions. On top of that, the extracellular matrix is responsible for all wound healing, so if you imagine cutting the body, you actually have to rebuild this very complex ECM in order to get it to form again, and a scar, in fact, is actually poorly formed extracellular matrix.
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現在我身後是描述細胞外基質的動畫。如你們所見,細胞散佈在這個複雜的網路中,細胞外基質隨組織部位而變化。因此目前市場上所有科技產品僅適用於二維結構的細胞外基質,這意味著它無法與組織本身聚合。因此當我身為紐約大學大一生時,我發現可藉由植物衍生的聚合物使傷口癒合。因此如果你有一個類似我身後正在流血的傷口,你可以把我們的材料塗在上面,就像樂高積木一樣,它將與該部位的組織聚合。因此這意味著如果你把它塗在肝臟上,它會變成類似肝組織的物質;如果你把它塗在皮膚上,它會變成類似皮膚組織的物質。因此當你塗上這種凝膠,它將與該部位的組織聚合。因此這種凝膠有很多用途,但其中的基本想法是,無論你把這個產品塗在哪裡都能立刻產生聚合作用。
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So now, behind me is an animation of the extracellular matrix. So as you see, your cells sit in this complicated mesh and as you move throughout the tissue, the extracellular matrix changes. So now every other piece of technology on the market can only manage a two- dimensional approximation of the extracellular matrix, which means that it doesn't fit in with the tissue itself. So when I was a freshman at NYU, what I discovered was you could actually take small pieces of plant-derived polymers and reassemble them onto the wound. So if you have a bleeding wound like the one behind me, you can actually put our material onto this, and just like Lego blocks, it'll reassemble into the local tissue. So that means if you put it onto liver, it turns into something that looks like liver, and if you put it onto skin, it turns into something that looks just like skin. So when you put the gel on, it actually reassembles into this local tissue. So now, this has a whole bunch of applications, but basically the idea is, wherever you put this product, you're able to reassemble into it immediately.
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這是動脈出血模擬-出血警告-動脈壓為正常的兩倍,因此這種出血情況相當嚴重,就像我之前說過的,需要花五分鐘以上的時間才能藉由施壓止血。在我介紹這種出血情況的期間,我們的材料就能止住這種程度的流血,因為它能在身體上產生作用,使傷口癒合。因此它能與這塊肉聚合,藉由流血情況可辨識出它正在起作用,產生纖維蛋白,十秒內迅速產生凝結物。因此現在這項技術-謝謝(掌聲)因此這項技術將在一月份交由獸醫試用,我們將盡力使醫生掌握這項技術,希望明年能達成目標。但我希望各位再想像一次:你是一名在戰場上奔跑的士兵,現在你腿部中槍,你不會面臨血液在三分鐘內流盡的情況,你從腰帶中拿出一小包凝膠,只要按下按鈕就能為自己止血,使傷口癒合,十分感謝。(掌聲)
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Now, this is a simulated arterial bleed — blood warning — at twice human artery pressure. So now, this type of bleed is incredibly traumatic,and like I said before, would actually take five minutes or more with pressure to be able to stop. Now, in the time that it takes me to introduce the bleed itself, our material is able to stop that bleed, and it's because it actually goes on and works with the body to heal, so it reassembles into this piece of meat, and then the blood actually recognizes that that's happening, and produces fibrin, producing a very fast clot in less than 10 seconds. So now this technology — Thank you. (Applause) So now this technology, by January, will be in the hands of veterinarians, and we're working very diligently to try to get it into the hands of doctors, hopefully within the next year. But really, once again, I want you guys to imagine that you are a soldier running through a battlefield. Now, you get hit in the leg with a bullet,and instead of bleeding out in three minutes, you pull a small pack of gel out of your belt, and with the press of a button, you're able to stop your own bleed and you're on your way to recovery. Thank you very much.