godfather of surgery

Chapter 1297 Expansion
August and Mainstein stood to the side. They hadn't yet digested Yang Ping's spatial theory genes, and now K therapy had emerged. They had originally planned to take some time to go to China to learn more, but to their surprise, K therapy suddenly swept the world like a whirlwind.

Several European hospitals began actively applying to become treatment centers for K-therapy, which caught Mainstein and August off guard. How could they miss out on such a good thing? They should be the ones promoting K-therapy.

Upon learning that Yang Ping had sent Li Guodong to Germany to guide the limited clinical trials of K therapy, they immediately put aside their work and began to join in. That's why they are now standing by and observing the first clinical trial of K therapy in Europe.

It's truly amazing that such a high-tech treatment method is as simple as an IV drip. Complex things ultimately become simple, which requires a great deal of technological support—Maninstein and August understood this principle. At the same time, they were also astonished that in such a short time, another world-class research achievement like K-therapy had been introduced.

The WeChat group started to get lively at this point.

Griffin: [I'm a senior in oncology, and I'm going to Sanbo this time. I've already booked my flight.]

Griffin is usually very low-key in the group, often lurking and only showing up when it's time to grab red envelopes.

Woodhead: [Have you passed your Chinese CET-4?]

Woodhead found it strange that Griffin had been silent in the group chat. Could it be that he had already passed the Chinese Level 4 exam? Impossible.

Griffin: [Passed Level 6.]

Woodhead: [Damn, you've already passed CET-6? How come I've never heard you mention it before?]

Woodhead was devastated because he had barely passed Level 4 after countless struggles, while Griffin, who hadn't uttered a word, had already passed Level 6.

"Actually, you don't need to worry about it so much. Griffin didn't mean anything by it. He just didn't want to upset you by not informing everyone about the national-level Chinese language achievement." Johannesson blurted out.

Woodhead never replied to the message again, which is another sad story.

[I, Griffin, am the first K-therapy trainee in the United States! Here I come, Sanbo!]

Griffin shouted, followed by a string of red envelopes.

The red envelope grabbing frenzy has already begun in the group chat.

Hans's K-formaldehyde infusion had finished, and he showed no reaction. Everyone stood by his bedside, seemingly with nothing to do or say; everything was too quiet.

"Are you feeling unwell?" August asked again.

Hans shook his head: "No."

“Not even a little bit?” Mainstein chimed in.

Hans thought for a moment: "With so many people surrounding me, I'm a little scared, does that count?"

When Mannstein turned around, he saw a dozen doctors standing straight with serious expressions, all lined up behind him, as if waiting for something big to happen.

……

In a small meeting room at the Waldorf Astoria Shanghai on the Bund, a subtle breakfast meeting is underway.

Wu Dechang's guests this time were quite special—three professors from China's top oncology field, and two technical leaders from state-owned pharmaceutical groups. There were no investors, no officials, just people from the front lines of technology.

"Good morning, experts." Wu Dechang's opening remarks were pragmatic. "I've invited you all here today not to discuss business or policy, but purely for technical exchange. Our scientific advisory group behind the 'Global Alliance for Equitable Healthcare' has conducted some independent analysis on the technical pathway of K therapy, and some of our findings may be worth discussing."

He gestured to his assistant to distribute materials, not a thick business plan, but several preprinted papers and data analysis reports.

Professor Chen adjusted his glasses, quickly glanced at the document, and frowned: "Are you questioning the target specificity of Factor K?"

“It’s not a question, but a possibility.” Wu Dechang pulled up a complex signaling pathway diagram. “Based on existing data, we speculate that the core mechanism by which factor K induces tumor cell apoptosis is through the activation of p53 and caspase family proteins. But there’s a problem here: some normal cells also highly express targeting markers on the surface of tumor cells under certain stress conditions. Theoretically, the K therapy carrier may inadvertently damage these normal cells.”

Another Professor Li shook his head: "The paper published by Professor Yang Ping's team in Nature Medicine shows that no such off-target toxicity was found in primate experiments."

“There is a gap between animal experiments and human applications.” Wu Dechang said calmly, “Moreover, we have noticed a detail: in the publicly available clinical data on K therapy, all cases involve a limited number of treatments. If this therapy needs to be used multiple times in the future, like chronic disease management, long-term safety data is lacking.”

This statement hits a crucial point. The experts present were well aware that if cancer treatment enters an era of "chronic disease" management, and K therapy truly proves effective with few side effects, then for certain high-risk groups or those with recurrent tumors, it might be used long-term or even lifelong, much like hypertension medication. Long-term safety is indeed a question that requires time to answer.

Currently, the clinical trials of K therapy only have short-term observation data from patients over a few months, and there is no long-term data, because the clinical trials have only just begun.

"Mr. Wu, what exactly are you trying to say?" a technical director from a state-owned pharmaceutical company asked bluntly.

“We want to launch a multi-center, independent, confirmatory clinical study.” Wu Dechang looked around at everyone. “It’s not about replicating K therapy, but about exploring alternatives based on the same principles but using different technical approaches. For example, using lentiviral vectors instead of adenovirus, using different combinations of pro-apoptotic genes, or even exploring non-viral delivery systems.”

He paused, observing everyone's reactions: "This research is completely open and transparent, with all data shared. If successful, we can establish an open-source tumor-targeted apoptosis therapy platform, upon which any qualified institution can develop its own treatment plans. Isn't that more beneficial to patients worldwide than having one company monopolize a technology?"

The meeting room fell silent as the experts exchanged glances. From a scientist's perspective, they instinctively welcomed the exploration of more research avenues; but from a practical standpoint, they also understood the underlying power dynamics.

"Where will the funding come from?" Professor Chen asked.

“Our international foundation!” Wu Dechang said. “We do not pursue short-term commercial returns; our goal is to build a public technology platform.”

"Then Ruixing and Sanbo..."

“Fair competition leads to scientific progress.” Wu Dechang smiled. “If Professor Yang Ping’s technology is truly irreplaceable, then no amount of research can shake its position. But if there is room for improvement, why not explore it? Isn’t that the spirit of science?”

"But why are you so sure that the core mechanism by which factor K induces tumor cell apoptosis is through the activation of p53 and caspase family proteins? I don't think so," Professor Zhao asked doubtfully.

Wu Changde thought to himself, "This is the retrograde analysis of our current scientific team. You guys should figure it out yourselves."

However, he did not say these words aloud. He only said, "We believe that if you have any doubts, you can find other routes and perhaps make a world-class discovery like Professor Yang. What I mean is, even if it is a similar route to his, we also have ways to make your results world-class."

At the end of the breakfast meeting, Wu Dechang spoke individually with each expert. He said the following to Professor Chen:

"Professor Chen, you are highly respected in the field of oncology in China. You should know best that China cannot have only one Yang Ping. We need a healthy and diverse research and development ecosystem. Today, we applaud the success of K therapy. But if other diseases emerge tomorrow, can we still expect there to always be a Yang Ping to step forward? What we need is a system, a mechanism, and a fertile ground for more 'Yang Pings' to emerge. And I believe that you are the expert who can achieve the same results as Yang Ping."

These words struck a chord with Professor Chen, who was eager to achieve extraordinary success. However, Wu Changde implied that they should decipher Yang Ping's K-therapy and then replicate it. They would repackage the replication technology and use their energy to create a new technology that could replace Yang Ping's technology.

As they left the hotel, the assistant whispered to Wu Dechang, "Boss, will they be involved?"

“Some will,” Wu Dechang said, looking at the Lujiazui skyline across the Huangpu River. “Because what I said is true. Long-term security needs to be verified, and the technical path can be diversified. More importantly, I gave them an irresistible reason: even if they take shortcuts, we have the ability to make them world-class scientists.”

“Huang Jiacai is currently busy with global expansion, which is exactly our opportunity. We can take them by surprise and replace their technology with our own,” Wu Changde said confidently.

……

Nandu News: Sanbo International Medical Education Institute has been established at 9:00 AM.

The lecture hall, which can accommodate 200 people, was packed. The first batch of 37 international students sat in the first three rows, while the back was crowded with visiting doctors and graduate students from major hospitals in China, and even a few gray-haired professors sat in the corner taking notes.

Today's speaker is Song Ziming, but he is not standing on the podium. Instead, he is sitting in the center of the first row, with a transparent simulated circulatory system device in front of him: pale red simulated blood flows in the transparent tubes, and an infusion pump and monitoring equipment are connected to the side.

"Everyone, we won't be having a theory class today." Song Ziming's voice carried through the microphone into the quiet classroom. "Today we'll only do one thing: see what happens when a drop of medicine enters the human body." He gestured to his assistant to start the device, simulating blood circulation. Song Ziming connected a small bottle of blue tracer to an IV tubing and slowly injected it.

The large screen simultaneously displays a microscopic simulation: countless blue dots enter the "blood vessels" and move with the blood flow. When they pass through a special filter labeled "tumor tissue," most of the blue dots are captured and remain there; while when they pass through the "normal tissue" area, the blue dots pass through quickly, leaving almost no trace.

“This is the core of K therapy: targeted delivery.” Song Ziming pointed to the screen. “The adenovirus vector itself has no therapeutic effect; it’s just a taxi. The real ‘passenger’ is the K factor gene it carries. The navigation system of this taxi is the target protein we modified, which only recognizes the ‘special address’ on the surface of tumor cells.”

Griffin eagerly raised his hand: "Dr. Song, how can we ensure that taxis don't go to the wrong address?"

“Good question.” Yang Ping pulled up a set of data. “That’s why we need to do gene sequencing and surface biomarker analysis on tumor tissue before each patient’s treatment. K therapy is not a panacea; it is only effective against tumors that express specific biomarkers. Currently, the biomarkers we have validated cover more than 70% of the subtypes of ten common solid tumors, including osteosarcoma, glioma, and breast cancer. We are working on the remaining 30%.”

He walked to the simulation device: "Now, who will operate a complete pre-treatment preparation process?"

Griffin raised his hand again, went up to the stage, and followed the steps in the training manual: verifying the batch number of the preparation, checking the clarity of the liquid, connecting the infusion line, setting the pump speed, and conducting a final double check... The whole process was as rigorous as defusing a bomb.

“Very good.” Song Ziming nodded, “but one step was missed.”

Griffin was stunned and thought back carefully.

“You didn’t explain to the simulated patient what was about to happen,” Song Ziming said. “Even if the patient has signed an informed consent form, even in the last minute before treatment, the doctor still has an obligation to tell him in the simplest terms what he will feel next, what might happen, and what to do if anything goes wrong. This is not a procedure, it is the duty of a doctor.”

The classroom was silent. This detail was only mentioned in a single line in the thick instruction manual. But Song Ziming placed it on an equal footing with checking the batch number.

“Treatment can be standardized, but care cannot.” Song Ziming looked at the trainees below the stage. “When you return to your own countries in the future, you may face patients who do not speak the language and have different cultures. But there is one thing in common: their fear of the unknown and their desire to survive. The bottle of medicine in your hands carries this desire. So, always explain one more thing, always look one more time, and always ask one more question, ‘How are you feeling?’”

The course continued. Song Ziming demonstrated how to manage common immune responses: which antipyretics to use for fever, at what level of muscle aches require intervention, and how to distinguish between a drug reaction and other issues when a rash appears. Each treatment plan was supported by data, drawn from real-world data on treated cases worldwide.

"Side effects are not scary; what's scary is being unprepared for them," said Song Ziming. "We can now control the incidence of severe immune reactions to below 3% and the rate of patients requiring intensive care to below 0.1%. But these figures are based on the premise of early detection and standardized treatment."

During the break, Huang Jiacai quietly appeared at the back door of the classroom. He didn't go in, but just stood there watching. He saw Song Ziming surrounded by students, patiently answering every question; he saw students taking notes, writing Song Ziming's words, "Always explain one more thing," on the title page of their handbooks; he saw several elderly Chinese doctors exchanging hushed conversations, nodding occasionally.

He turned and left, his steps light. On the walls of the corridor hung photos and biographies of the trainees: Hans from Germany, Griffin from the United States, Rajiv from India, Carlos from Brazil, Tanaka from Japan... Behind each photo, there was a potential impact on the fate of hundreds or thousands of patients in the coming years.

……

1 a.m., the main laboratory of the Sanbo Research Institute.

Yang Ping wasn't analyzing data or writing papers; instead, he was observing a group of cells in an incubator. This was a special sample that had just been shipped from a hospital in Shanghai that day—tumor cells from a pancreatic cancer patient. This type of cancer is known as the "king of cancers" because it has an extremely poor prognosis and is almost entirely resistant to existing treatments.

The accompanying medical records showed that the patient had tried all standard treatments, but the tumor was still progressing. The family eventually contacted Sanbo to inquire about the possibility of K therapy.

Yang Ping conducted preliminary tests, and the results were not optimistic: the surface markers of these pancreatic cancer cells were expressed very weakly, and existing K therapy vectors may not be able to effectively recognize and infect them.

"Professor, this... case... should we refuse it?" Xu Zhiliang asked.

"Not yet." Yang Ping pulled up the cell's whole genome sequencing data. "Let's see if there are any other weaknesses that can be targeted."

After several hours of analysis, they discovered an interesting clue: although these cells lacked conventional targets, they highly expressed a rare receptor protein that usually only appears in early embryonic development.

“Perhaps we can modify the vector to target this receptor,” Song Ziming suggested.

"But it hardly expresses anything in normal adult tissues, so its safety is questionable." Yang Ping pondered. "We need to do more verification experiments. If it's feasible, it might open a new door."

Just then, the lab door was gently pushed open. Huang Jiacai walked in, carrying an insulated bag—dumplings again tonight.

"I heard you're researching a new case." Huang Jiacai put down the insulated box. "Pancreatic cancer?"

"how do you know?"

"The patient's family also contacted Ruixing." Huang Jiacai sat down at the lab bench. "They were willing to pay any fees and even offered to donate money to support related research."

Yang Ping frowned: "Treatment is not a transaction."

“I know. That’s why I had the medical team handle it according to standard procedures.” Huang Jiacai opened the insulated box. “But this incident made me think about a problem: as K therapy becomes more and more famous, more and more patients will come to us with a ‘last-ditch effort’ mentality. We can’t treat everyone, especially those cases that current technology is truly powerless to treat. Refusing will leave patients in despair; accepting but failing may damage the reputation of the technology.”

Yang Ping took the wontons, the steam blurring his glasses: "So what's your suggestion?"

"We will establish a strict admission assessment committee," Huang Jiacai said. "Those who meet the standards will receive the best possible treatment; those who do not will be clearly informed of the reasons. This will protect patients from excessive expectations and also prevent the technology from being abused."

This suggestion is very pertinent. Yang Ping nodded: "Okay, but the committee must have genuine academic independence and cannot be influenced by business or personal relationships."

“I understand.” Huang Jiacai looked at Yang Ping’s tired face. “There’s another piece of news you might need to know. A man named Wu Dechang has contacted some of our potential partners in Shanghai. He has proposed the concept of an ‘open source alternative’.”

Yang Ping paused in his eating of dumplings for a moment, then continued: "Science should be open."

“But the timing is very delicate,” Huang Jiacai said. “The entry point he chose is long-term security verification and diversification of technical paths. These two points are precisely what we cannot completely refute at this stage—long-term security takes time, and technical diversification is indeed beneficial in theory.”

"so what?"

“Therefore, we need to plan ahead.” Huang Jiacai pulled up a planning map on his tablet. “I suggest that we proactively invite international authoritative institutions to launch a ten-year long-term safety tracking study on K therapy. At the same time, we should disclose some non-core technologies and encourage the academic community to conduct optimization research in areas such as targeting strategies and delivery systems. We should guide the competition onto the track we have set.”

Yang Ping put down his spoon, looked at Huang Jiacai seriously, and agreed with his suggestion.

“In the past, you were thinking about how to protect and control it. Now you are thinking about how to guide and build an ecosystem,” Yang Ping said. “This is right. If a technology can really change the world, it should not and cannot be completely controlled by any one company.”

Huang Jiacai laughed: "Actually, you taught me this. You always say that the purpose of medical progress is to benefit more people. To achieve this goal, sometimes we need to let go of some of our desire for control."

In the lab, everyone ate dumplings and discussed strategic issues that could influence the future global landscape of cancer treatment.

"Regarding that pancreatic cancer case," Huang Jiacai asked as he was leaving, "how confident are you?"

"I don't know," Yang Ping said honestly. "It might require designing entirely new carriers and a lot of validation experiments. The success rate... is probably less than 10%, after all, it's no longer within the scope of existing K-therapies, and we are working hard to expand its scope of application."

"Then why do it at all?"

"Because if it succeeds, it could bring hope to thousands of similar patients." Yang Ping put his gloves back on. "A 10% chance is worth trying with 100% effort."

Huang Jiacai nodded without saying anything more. He gently closed the door, and his footsteps gradually faded into the empty corridor.

In the laboratory, Yang Ping returned to the incubator. Under the microscope, the stubborn pancreatic cancer cells continued to divide and proliferate, like invisible enemies ravaging the patient's body.

In his hand, the pipette contained the prototype fluid of the newly designed next-generation carrier, its pale blue fluorescence shimmering faintly under the light.

Yang Ping himself didn't know how broad the scope of K therapy could be, because both the target and the K factor could limit its applicability. Without a target, it lacks precise infection capabilities. If the K factor cannot activate the apoptosis program of the target tumor cells, it will not have the ability to eliminate the tumor.

What Yang Ping needs to do now is to continue searching for new tumor targets and factor K.

The K-factor must be a family, and he has not yet figured out the internal rules of this family, so he cannot find the other members of this family.