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We need to shine light to see what we're doing. | Dobbiamo illuminare per vedere cosa stiamo facendo. | en-it |
And this is why, traditionally, surgeries have always started so early in the morning -- to take advantage of daylight hours. | Daarom begonnen operaties traditioneel altijd zo vroeg in de ochtend - om te profiteren van de uren met daglicht. | en-nl |
And if you look at historical pictures of the early operating rooms, they have been on top of buildings. | 그리고 초기 수술실의 예전 사진들을 보면, 건물의 꼭대기에 위치해 있었습니다 | en-ko |
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. | Na primjer, ovo je najstarija operacijska sala u zapadnome svijetu, u Londonu, i ona se nalazi na vrhu crkve i danja svijetlost dopire unutra. | en-hr |
And then this is a picture of one of the most famous hospitals in America. | そしてこれはアメリカでもっとも有名な 病院のひとつである | en-ja |
This is Mass General in Boston. | Mass General în Boston. | en-ro |
And do you know where the operating room is? | ואתם יודעים איפה חדר הניתוח? | en-he |
Here it is on the top of the building with plenty of windows to let light in. | Ovde je na vrhu zgrade osvetljena dnevnom svetlošću. | en-sr |
So nowadays in the operating room, we no longer need to use sunlight. | Dziś na sali operacyjnej nie polegamy na świetle słonecznym. | en-pl |
And because we no longer need to use sunlight, we have very specialized lights that are made for the operating room. | Már nem használjuk a napfényt, mert különleges lámpáink vannak, amelyek műtőknek készülnek. | en-hu |
We have an opportunity to bring in other kinds of lights -- lights that can allow us to see what we currently don't see. | Wir haben die Möglichkeit, andere Lichtarten zu benutzen -- Licht, das uns Dinge zeigt, die wir heute nicht sehen. | en-de |
And this is what I think is the magic of fluorescence. | 這種光線就是 神奇的螢光 | en-zh-tw |
So let me back up a little bit. | 我想再解释一下。 | en-zh-cn |
When we are in medical school, we learn our anatomy from illustrations such as this where everything's color-coded. | Studiując w szkole medycznej, uczymy się anatomii z takich oto ilustracji, na których wszystko jest oznaczone odpowiednim kolorem. | en-pl |
Nerves are yellow, arteries are red, veins are blue. | Az idegek sárgák, az ütőerek vörösek, a visszerek kékek. | en-hu |
That's so easy anybody could become a surgeon, right? | Så enkelt att vem som helst kunde bli kirurg, eller hur? | en-sv |
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. | Sin embargo, cuando tienes un paciente real en la mesa, esta es la misma disección de cuello... no es tan fácil ver la diferencia entre las diferentes estructuras. | en-es |
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. | 最近，我们听说 现在癌症 还是我们社会中的一个紧迫问题。 我们迫切的希望， 不会 每分钟都有人死于癌症。 | en-zh-cn |
Well if cancer can be caught early, enough such that someone can have their cancer taken out, excised with surgery, 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. | Kad rak mogao biti rano otkriven, dovoljno da ga možemo izvaditi, kirurški odstraniti, nije me briga ima li ovaj ili onaj gen, ili ovaj ili onaj protein, on je sad u posudi. | en-hr |
It's done, it's out, you're cured of cancer. | Gotovo je, vani je, vi ste izliječeni od raka. | en-hr |
This is how we excise cancers. | Đây là cách chúng tôi cắt bỏ những khối u. | en-vi |
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. | 저희는 저희가 배운 것, 암 그 자체, 느끼는 대로, 암과 다른 구조와의 관계, 그리고 저희의 모든 경험에 근거해서 최선을 다 하고 암은 제거되었다고 말하죠 | en-ko |
We've made a good job. We've taken it out. | עשינו עבודה טובה. הוצאנו אותו. | en-he |
That's what the surgeon is saying in the operating room when the patient's on the table. | Ezt szokták mondani a sebészek a műtőben az operált páciensnek. | en-hu |
But then we actually don't know that it's all out. | 하지만 저희는 실제로 암의 모든 부분이 제거되었는 지는 모릅니다 | en-ko |
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. | אנחנו למעשה צריכים לקחת דגימות ממצע הניתוח, ממה שנשאר בתוך החולה, ולשלוח את החלקים האלו למעבדה פתולוגית. | en-he |
In the meanwhile, the patient's on the operating room table. | Nel frattempo, il paziente è sul tavolo operatorio. | en-it |
The nurses, anesthesiologist, the surgeon, all the assistants are waiting around. | 看護師 麻酔医 外科医 そして 助手は待っているのです | en-ja |
And we wait. | Y esperamos. | en-es |
The pathologist takes that sample, freezes it, cuts it, looks in the microscope one by one and then calls back into the room. | Patologul ia mostra, o îngheaţă, o taie, o analizează la microscop una câte una şi apoi ne anunță în sală. | en-ro |
And that may be 20 minutes later per piece. | Ez mintánként 20-20 perc. | en-hu |
So if you've sent three specimens, it's an hour later. | 그러니까 3조각의 샘플을 보냈다면, 한 시간 정도 걸린다는 말이죠 | en-ko |
And very often they say, "You know what, points A and B are okay, but point C, you still have some residual cancer there. | و في كثير من الاحيان يقولون "اتعلم... النقطتين "أ" و "ب" سليمتان لكن النقطة "ج" ماتزال تحتوي على سرطان | en-ar |
Please go cut that piece out." | Snijd dat ook maar weg." | en-nl |
So we go back and we do that again, and again. | Also gehen wir zurück und tun das, immer wieder. | en-de |
And this whole process: "Okay you're done. | đó là tòan bộ quá trình: "Xong, chúng ta ổn | en-vi |
We think the entire tumor is out." | Achamos que todo o tumor foi removido." | en-pt |
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, we actually found that there's a couple other spots where the margins are positive. | Maar heel vaak krijgen we enkele dagen later, als de patiënt al naar huis is, een telefoontje: "Het spijt me, toen we naar de finale pathologie keken, naar het finale specimen, vonden we eigenlijk nog een paar andere plekken met positieve marges. | en-nl |
There's still cancer in your patient." | Seu paciente ainda tem câncer." | en-pt-br |
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. | こうなると医者は 自分の患者に 再手術の可能性だとか 放射線療法や化学療法などの 追加の治療が必要なことを 伝えねばならなくなります | en-ja |
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? | Deci n-ar fi mai bine dacă am putea ști, dacă chirurgul ar putea vedea într-adevăr, dacă mai există sau nu cancer în câmpul operator? | en-ro |
I mean, in many ways, the way that we're doing it, we're still operating in the dark. | 제 말은, 저희가 수술을 하는 데 있어서, 여러모로 어둠 속에 있다는 의미입니다 | en-ko |
So in 2004, during my surgical residency, I had the great fortune to meet Dr. Roger Tsien, who went on to win the Nobel Prize for chemistry in 2008. | Dok sam bila na hirurškom usavršavanju 2004. imala sam veliku sreću da upoznam dr Rodžera Čena, koji je kasnije dobio Nobelovu nagradu za hemiju 2008. | en-sr |
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. | Роджер и его коллеги работали над способом выявления рака, и у них была весьма "умная" молекула, выявленная ими в ходе длительного труда. | en-ru |
The molecule they had developed had three parts. | 開発していました 彼らが開発した分子は 3つの部分からできています | en-ja |
The main part of it is the blue part, polycation, and it's basically very sticky to every tissue in your body. | La parte principal es la azul, un policatión, que es básicamente muy pegajoso para todos los tejidos del cuerpo. | en-es |
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. | 그러니까 이 끈끈한 물질로 이루어진 화합물을 만들어서 암을 가지고 있는 사람의 정맥에 주사하면 모든 것이 빛을 낸다고 생각해 보세요 | en-ko |
Nothing will be specific. | 特異的なものはありません | en-ja |
There's no specificity there. | Няма специфичност там. | en-bg |
So they added two additional components. | Así que le añadieron dos componentes adicionales. | en-es |
The first one is a polyanionic segment, which basically acts as a non-stick backing like the back of a sticker. | Първият е полианионен сегмент, който се държи като незалепващ съпровод, като задната част на тиксо. | en-bg |
So when those two are together, the molecule is neutral and nothing gets stuck down. | אז כששני אלו ביחד, המולקולה ניטרלית ולא נדבקת לשום דבר. | en-he |
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. | И тогава двете частици са свързани чрез нещо, което може да бъде отрязано, само ако имате правилните молекулярни ножици - например, този вид ензимни протеази, които туморите правят. | en-bg |
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. | 즉 여기서 이 세 분자와 초록색으로 보이는 염료로 가득한 화합물을 만들어서 암환자의 정맥에 주사를 하면, 일반 세포는 절단할 수 없습니다 | en-ko |
The molecule passes through and gets excreted. | 溶液的分子流經組織，然後代謝掉 | en-zh-tw |
However, in the presence of the tumor, now there are molecular scissors that can break this molecule apart right there at the cleavable site. | Toutefois, en présence de la tumeur, maintenant il y a des ciseaux moléculaires qui peut briser cette molécule juste là à l'endroit clivable. | en-fr |
And now, boom, the tumor labels itself and it gets fluorescent. | És most, csiribí-csiribá, a daganat megjelöli magát, és fluoreszkálni kezd. | en-hu |
So here's an example of a nerve that has tumor surrounding it. | 这是一根神经， 周围有肿瘤 | en-zh-cn |
Can you tell where the tumor is? | Ser ni var tumören är? | en-sv |
I couldn't when I was working on this. | Tôi không thể khi làm việc với nó. | en-vi |
But here it is. It's fluorescent. | Ma eccolo qui. È fluorescente. | en-it |
Now it's green. | עכשיו הוא ירוק. | en-he |
See, so every single one in the audience now can tell where the cancer is. | 緑色に見えます そう 今なら皆さん全員が ガンの位置が分かりますね | en-ja |
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. | نحن نستطيع في غرفة العمليات,في ميدان العمل على مستوى جزيئي حيث السرطان و ما على الجراح فعله ومقدار العمل الذي يجب فعله لاستأصال الورم | en-ar |
And the cool thing about fluorescence is that it's not only bright, it actually can shine through tissue. | また 蛍光のすごいところは 明るいだけではなく 組織を透過して光るところです | en-ja |
The light that the fluorescence emits can go through tissue. | האור שהפלואורסצנטיות מקרינה יכול לעבור דרך רקמות. | en-he |
So even if the tumor is not right on the surface, you'll still be able to see it. | 因此即使肿瘤表面不亮， 我们仍然可以看到它。 | en-zh-cn |
In this movie, you can see that the tumor is green. | În acest film, puteţi observa că tumoarea e verde. | en-ro |
There's actually normal muscle on top of it. See that? | Ovdje iznad zapravo je normalno mišićno tkivo. | en-hr |
And I'm peeling that muscle away. | ¿Lo ven? Y yo estoy retirando este músculo. | en-es |
But even before I peel that muscle away, you saw that there was a tumor underneath. | Dar chiar înainte de a decoji acel muşchi, aţi văzut că dedesubt exista tumoare. | en-ro |
So that's the beauty of having a tumor that's labeled with fluorescent molecules. | Questa è la cosa bella dell'avere un tumore etichettato con molecole fluorescenti. | en-it |
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. | Poţi vedea nu doar marginile până la nivel molecular, ci o poţi vedea chiar dacă nu e deasupra -- chiar dacă se află în afara câmpului vizual. | en-ro |
And this works for metastatic lymph nodes also. | Dies funktioniert auch für metastasen-bildende Lymphknoten. | en-de |
Sentinel lymph node dissection has really changed the way that we manage breast cancer, melanoma. | A dissecção de linfonodo sentinela mudou nossa conduta em relação ao câncer de mama, melanoma. | en-pt-br |
Women used to get really debilitating surgeries to excise all of the axillary lymph nodes. | A las mujeres se acostumbraba hacerles cirugías realmente invalidantes extirpando todos los ganglios linfáticos axilares. | en-es |
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. | Но когато първият засегнат сентинелен лимфен възел влезе в нашия протокол на лечение, хирургът всъщност търси единствения възел, който е първият дрениращ лимфен възел на рака. | en-bg |
And then if that node has cancer, the woman would go on to get the axillary lymph node dissection. | 假如這個淋巴結帶有腫瘤 該名女性病患 必須接受腋下淋巴結切除術 | en-zh-tw |
So what that means is if the lymph node did not have cancer, the woman would be saved from having unnecessary surgery. | O que isto significa é que se o nódulo sentinela não tiver cancro, a mulher é poupada a uma cirurgia desnecessária. | en-pt |
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. | De ma a jelző nyirokcsomó olyasmi, mint egy térkép, amelyből megtudjuk, merre menjünk. | en-hu |
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. | Se estiverem a conduzir na auto-estrada e quiserem saber onde é a próxima bomba de gasolina, têm um mapa que vos diz que a bomba é lá mais à frente. | en-pt |
It doesn't tell you whether or not the gas station has gas. | היא לא אומרת לך אם יש בתחנה דלק או לא. | en-he |
You have to cut it out, bring it back home, cut it up, look inside and say, "Oh yes, it does have gas." | Usted tiene que cortar, llevarlo a casa, cortarlo, mirar dentro, y decir, "Oh sí, tiene gasolina". | en-es |
So that takes more time. | Do đó tốn nhiều thời gian. | en-vi |
Patients are still on the operating room table. | Пациенты всё ещё на операционном столе. | en-ru |
Anesthesiologists, surgeons are waiting around. | Anesteziştii, chirurgii sunt prin jur, în aşteptare. | en-ro |
That takes time. | 時間がかかるのです | en-ja |
So with our technology, we can tell right away. | 但是用我们的技术立即就可以知道。 | en-zh-cn |
You see a lot of little, roundish bumps there. | Vidite ovde mnogo malih, okruglastih izbočina. | en-sr |
Some of these are swollen lymph nodes that look a little larger than others. | 이중 일부는 다른 것보다 약간 커 보이는 부어오른 림프절입니다. | en-ko |
Who amongst us hasn't had swollen lymph nodes with a cold? | Wer von uns hatte nicht geschwollenen Lymphknoten während einer Erkältung? | en-de |
That doesn't mean that there's cancer inside. | Это ведь не значит, что в них есть раковые клетки. | en-ru |
Well with our technology, the surgeon is able to tell immediately which nodes have cancer. | 運用我們的技術 外科醫生可以馬上知道 哪個淋巴結有腫瘤 | en-zh-tw |
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. | Nu voi elabora foarte mult, dar tehnologia noastră, pe lângă faptul că poate marca tumorile și nodurile limfatice metastatice cu fluorescenţă, poate folosi această moleculă ingenioasă din trei părţi pentru a eticheta Gd, gadoliniul în sistem în mod non-invaziv. | en-ro |
The patient has cancer, you want to know if the lymph nodes have cancer even before you go in. | De patiënt heeft kanker, je wil weten of er in de lymfeklieren kanker is zelfs voordat je naar binnen gaat. | en-nl |
Well you can see this on an MRI. | MRI-vel láthatóvá tehetők. | en-hu |
So in surgery, it's important to know what to cut out. | אז במהלך הניתוח זה חשוב לדעת מה לחתוך ולהוציא. | en-he |
But equally important is to preserve things that are important for function. | Maar het is even belangrijk om dingen die belangrijk voor de functie zijn, te sparen. | en-nl |
So it's very important to avoid inadvertent injury. | Затова е много важно да се избягва нехайно нараняване. | en-bg |
And what I'm talking about are nerves. | وما اتحدث عنه هي الاعصاب | en-ar |
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