godfather of surgery

Chapter 1301 Professor, I've Discovered Another Secret

Dr. Carlos from Brazil did not give up. After the first patient gave up treatment due to distrust, he contacted the local medical association and patient organizations and held a small-scale popular science seminar on K therapy. Most of the attendees were late-stage patients and their families, whose eyes reflected similar despair and longing.

Carlos didn't hide anything: efficacy, side effects, economic burden, and technological uncertainties. He showed operational videos from the Tribune training course, international case data, and frankly discussed the problems with adenovirus antibody screening and the limitations of current solutions.

“Doctor, we understand what you’re saying,” said a middle-aged man who was consulting for his wife. “But how can we believe this isn’t another scam? We’ve seen too many miracle cures end up leaving people penniless and heartbroken.”

Indeed, many scammers exploit the survival instincts of terminally ill patients by promoting various miraculous treatments to swindle money, making it difficult for patients to distinguish between genuine and fake treatments.

“Professor Yang Ping, the inventor of K therapy, is a Nobel laureate…” Carlos tried his best to explain.

However, the patient's family member said, "Many miracle cures claim to have Nobel Prizes or other high-end backgrounds, making it really hard for us to tell the difference between the real and fake."

Carlos paused for a moment, unsure how to answer the question.

Trust is something that is very difficult to build; many issues are no longer medical problems, but rather social problems.

That day, Carlos received only one treatment request. The patient was a wealthy man who didn't care about money; he just wanted to give it a try. Since there was no other way, he was willing to try even if it was a scam.

……

Shen Guohua began his second treatment: intravenous infusion of dual-target A/B vectors, along with a precisely controlled infusion of immunomodulators.

On the first night after treatment, Shen Guohua's body temperature rose to 38.5℃ and his heart rate increased, but his blood pressure and blood oxygen saturation remained stable. This was the expected immune activation response, which was within a controllable range.

At 3 a.m., Song Ziming, who had been monitoring various test data, suddenly noticed: "Interleukin-6 and interferon-γ are rising rapidly, but tumor necrosis factor-alpha remains stable. This pattern is different from the previous simple vector therapy!"

This is a good sign, indicating that immunomodulators are working, activating smarter immune response pathways rather than a blind cytokine storm.

The following morning, Shen Guohua experienced a significant increase in abdominal pain, but unlike the previous cancer pain, it was a dull ache accompanied by a feeling of distension. An ultrasound revealed obvious liquefactive necrotic lesions in the pancreatic tumor area, while the boundaries of the liver metastases also became blurred.

"The tumor is dissolving!" Dr. Li Chao's voice was filled with excitement.

But bad news followed. At noon, Shen Guohua's bilirubin levels began to rise slowly again, and his coagulation function indicators showed slight abnormalities.

"Tumor lysis may release a large amount of intracellular substances, which increases the metabolic burden on the liver," Yang Ping judged. "Strengthening support is needed."

The support plan has been adjusted again: on one hand, the tumor is receding, and on the other hand, the body is bearing the cost of the receding tumor. The weights on both sides of the scale are constantly being added or subtracted.

Another forty-eight hours have passed.

After Shen Guohua's bilirubin level reached a certain plateau, it began to decline slowly but steadily. His coagulation function returned to normal, his abdominal pain lessened, and the tumor marker CA19-9 dropped to 5200 U/mL.

Most excitingly, the latest single-cell sequencing shows that some of the cunning tumor cells that had entered a dormant state by highly expressing rare receptors have become active again under the influence of changes in the immune microenvironment and metabolic stress. They have also shown new signs of activity, with stress proteins produced as they try to adapt to the new environment being recognized by certain activated immune cells.

"The ground forces have discovered the hidden enemy strongholds. Although they haven't been completely eliminated yet, at least they can't hide anymore. This battle is going to be tough," Yang Ping said confidently. He had vaguely figured out something else, but he couldn't quite put his finger on it yet.

Shen Guohua's vital signs stabilized, and he was transferred from the ICU to a high-risk bed in a regular ward. He was still weak, but could drink some water and say a few words.

“Professor Yang…” he said softly.

Yang Ping leaned closer.

"Thank you...you...for not giving up." Every word was difficult to utter.

“It’s because you didn’t give up.” Yang Ping held his hand. “Rest well. The battle isn’t over yet, but we’ll get you through the toughest part. What follows is a protracted war.”

Shen Guohua's lips twitched, like a smile, before he fell into a deep sleep.

Three days later, Shen Guohua was transferred from a high-risk ward to a regular single room, indicating that his condition had stabilized.

However, medical stability is relative. Shen Guohua's primary pancreatic lesion shrank by 40%, the liver metastases partially liquefied and necrotized, and CA19-9 decreased to 3200 U/mL. This deserves a case report published in a top medical journal.

However, he still had a considerable number of residual tumor cells in his body. These cells no longer highly expressed any known common receptors, but instead began to secrete trace amounts of factors that could disrupt local nerve and angiogenesis, causing Shen Guohua to experience indescribable dull pain and weakness from time to time.

"It's like guerrillas going underground, not engaging in direct combat, but constantly causing damage to deplete your resources and will," Yang Ping analyzed. "Our mission has shifted from annihilation warfare to counterinsurgency warfare, requiring a long-term, low-intensity, multi-target maintenance strategy."

The maintenance regimen was quickly formulated: monthly low-dose dual-target vector infusion, two oral medications to regulate the tumor microenvironment and metabolism, combined with strict nutritional support and appropriate rehabilitation exercises. Simultaneously, comprehensive blood and imaging monitoring was conducted weekly to track the evolution of tumor cells in real time.

"This means that Mr. Shen will become our first patient with advanced pancreatic cancer under long-term management," said Dr. Li. "His treatment will not have a definite end date; it may last for several years, or even a lifetime, or it may be cured next month."

Shen Guohua and Zhou Min understood. There was no cure, only control; like high blood pressure or diabetes, they would live with cancer for a long time.

"As long as you're alive, that's enough." Shen Guohua said only four words and tightened his grip on his wife's hand.

From the despair at the time of diagnosis, to the perilous treatment, and now to living with the disease, this is the best possible outcome.

Any patient with advanced malignant tumor would jump for joy if they heard that, like high blood pressure and diabetes, they could live with the disease and have it under control for life.

Yang Ping was pondering why K-therapy could cure osteosarcoma but not pancreatic cancer. He reasoned that K-factor was specifically designed to target osteosarcoma. Whether it was targeting and locking onto the target or initiating a targeting process, osteosarcoma cells had no way to retaliate. No matter how they tried to escape, they could not escape being hunted down. However, K-factor was ineffective against pancreatic cancer because it lacked a specific and stable target and could only use ordinary targets, which were subject to change at any time.

……

Ruixing Company Conference Room.

Huang Jiacai laid out two reports in front of him. One was from the market intelligence department, which provided a detailed analysis of the developments of Wu Changde's open platform in the month since its launch: 43 domestic and foreign research institutions had registered to use the "cornerstone" module; and eight "collaborative R&D projects" had been launched on the platform.

A mid-sized biopharmaceutical company in East China announced that it has completed the simulated construction of a CAR-T vector targeting a lung cancer target in just eight weeks using a platform module and has launched experimental research.

Wu Changde's team published two papers in the top academic journal Nature Biotechnology, outlining their modular design concept and preliminary verification data, which have led to a surge in citations.

Rumors have circulated that Wu Changde is in contact with a well-known international open-source software foundation, hoping to internationalize the platform's "open-source" governance model.

The report concludes that open platforms are rapidly gaining popularity, resources, and prestige, and their ecosystem effects are beginning to emerge.

Regarding Wu Changde's research, Dr. Walker, a former senior scientist at BG Group, privately expressed great concern. He argued that Wu Changde underestimated the technological sophistication of K-therapy, pointing out that Wu Changde completely misunderstood the technology and that all current investments were a waste of resources, potentially leading to a series of serious problems. He added that even replicating the original technology, let alone researching it, would take several years.

Another report comes from Ruixing's own R&D and clinical team:
The global cumulative number of cases treated with K therapy has exceeded 500 (including clinical trials and compassionate use), with an overall objective response rate of 78% and a complete response rate of 22%.

The newly developed dual-target carrier process is becoming stable, and the GMP production line upgrade is 60% complete.

The "hybrid vector library" strategy, addressing the issue of pre-existing adenovirus immunity, has demonstrated value in compassionate use cases in Europe, successfully matching effective vectors for 17 antibody-positive patients. The long-term maintenance management model derived from Shen Guohua's case is forming a standardized protocol framework. This approach is undoubtedly another innovation, and before the advent of a definitive treatment, it can guarantee patient survival rates.

……

The Frankfurt Mirror Center has been completed and is now in the final sprint stage of equipment commissioning and EU safety certification.

The report also outlines problems and challenges: treatment costs remain high; despite tiered pricing under the universal healthcare framework, the total cost of a single treatment still exceeds 50 RMB, and negotiations for health insurance coverage are progressing slowly around the world.

International medical teams, such as Carlos and Rajiv, reported a wide variety of practical problems, ranging from cold chain logistics disruptions to conflicts with local medical regulations, which consumed a lot of support resources.

Zurich, internal briefing of the European Commission's Directorate-General for Health.

Carl Schmidt is reporting to senior management on the first month of the K therapy “compassionate use” program.

"As of yesterday, a total of 41 compassionate use applications have been approved within the EU (including associate countries such as Switzerland and Norway). These applications involve eight types of solid tumors, including pancreatic cancer, cholangiocarcinoma, and glioblastoma multiforme. Treatment has been completed in 22 cases so far."

"Early data show that the objective response rate (ORR) was 81.82%, and in terms of safety, the incidence of grade 3 or above adverse reactions was 4.55%, mainly controllable cytokine release syndrome and transient liver function impairment, with no treatment-related deaths."

"The data channel through the Frankfurt mirror center is operating smoothly. The joint monitoring committee held three meetings and reviewed a suspected case of unexpected serious adverse event. It was determined that the event was related to the progression of underlying diseases and no interruption of the program was required."

"Feedback from patient organizations and the media has been generally positive, with many believing it represents a good balance between regulatory flexibility and the protection of patient rights."

“However,” Carl changed the subject, “we have also observed some challenges. First, the treatment costs are high. Even though Ruixing covers some of the monitoring costs, most of the costs still need to be paid by national health insurance or by the patients themselves, highlighting the issue of fairness. Second, some member states have expressed concern about the expansion of compassionate use, believing that it may undermine the authority of the formal approval process and indirectly encourage medical tourism. Finally, Ruixing’s proposed efficacy risk-sharing insurance model faces complex insurance regulatory obstacles in Europe.”

One committee member asked: "So, Dr. Schmidt, what is your overall assessment? Should this temporary pathway continue, or even be expanded? Should the formal approval process be expedited?"

After a moment of silence, Carl offered a rigorous answer: "From a purely medical and patient benefit perspective, we should continue, and even consider appropriately expanding the scope of diseases covered. From a regulatory and systemic risk perspective, we need to establish clearer exit mechanisms and conversion pathways. If K therapy ultimately fails to obtain formal approval for marketing, how will the subsequent treatment and data of these compassionate use patients be handled? In addition, we need to begin serious discussions on how to incorporate the costs of such breakthrough therapies into a sustainable healthcare system. This is not just a regulatory issue, but also a health economics and social policy issue."

"So, what's your suggestion?"

“I propose the establishment of an inter-departmental working group, including experts in health, economics, law, and data protection, to specifically study sustainable access models for breakthrough therapies in Europe. We cannot always use temporary channels; we need a long-term mechanism.”

This suggestion was endorsed by the majority of the committee members. The meeting decided that Carl would lead the preparation of this working group.

After the meeting, Lillian Windsor called Carl over.

“Karl, it seems you’ve made a change?” Lillian smiled. “Before, you prioritized rules and risks, but now you’re actively pushing forward K therapy.”

Karl gave a wry smile: "Perhaps it was you who forced me to this, and also the faces behind those data. Last week I went to Heidelberg University Hospital to visit a glioblastoma patient receiving compassionate use, a 30-year-old physics PhD student. He told me that if he could live another year, he could finish his doctoral dissertation, which might make a small contribution to quantum computing. At that moment, I wondered, are our rules meant to protect people like him, or might they inadvertently stifle their hopes?"

“So we need to design the rules to be smarter,” Lillian said. “Not to hinder, but to accelerate safely, and most importantly, our evaluation of every decision should be objective, not biased.”

“Correcting prejudice is the hardest part. Just because I’ve corrected it now doesn’t mean others can,” Karl replied.

……

Southern Metropolis Daily, Sanbo Research Institute.

Before Yang Ping lay Shen Guohua's latest in-depth analysis report on single-cell sequencing data. The report showed that, in addition to secreting disruptive factors, the latent tumor cells were exhibiting an abnormally high mutation rate in their genomes and were showing characteristics of microsatellite instability.

“Increased genomic instability.” Yang Ping pointed to the mutation spectrum. “This means they are accelerating their trial and error, searching for new survival strategies, but it also means they may be more sensitive to certain DNA damage repair inhibitors or immune checkpoint inhibitors, which is a weakness.”

Song Ziming's eyes lit up: "Could we try adding a low dose of PARP inhibitor to the maintenance regimen? Or, could we combine it with a milder PD-1 inhibitor during the next vector infusion?"

“Theoretically, there is a synergistic effect, but extremely precise dosage exploration is needed to prevent additive toxicity.” Yang Ping pondered, “Mr. Shen’s liver and bone marrow functions are currently like a taut string. Adding any new drug may disrupt the balance.”

"But if we don't add anything, the tumor might find a way to completely escape during its accelerated mutation," Lu Xiaolu warned.

“Therefore, we need more accurate data as a foundation to master the art of balance,” Yang Ping murmured.

Much of the data was obtained through trial and error, and Yang Ping decided that he should now take some time to collect data at the System Space Laboratory.

The automatic door to the laboratory opened gently, and Zhang Lin came in carrying several bottles of milk tea, which he placed on the table.

Zhang Lin said, "Professor, let's take a break and have some milk tea. Let's all have some milk tea together."

Yang Ping looked at the milk tea: "Did you need something from me?"

Zhang Lin had been looking for Professor Yang for several days, but Professor Yang was always busy. He waited for several days and finally got this free time.

"Professor, I have a question I'd like to ask you?" Zhang Lin felt a little embarrassed to bother Yang Ping.

"Go ahead and say it," Yang Ping said.

Zhang Lin glanced around mysteriously, as if he were about to reveal a secret.

"Should we leave?" Song Ziming pointed at everyone.

"no, I'm fine!"

Zhang Lin chuckled.

"Professor! Professor, I've discovered another secret. This secret could be used to set up a new research topic, and it might even win the Nobel Prize."

I rely on!

Professor Zhang was no longer satisfied with just surgical retractor techniques; he wanted to aim for the Nobel Prize. Not only Song Ziming, but everyone else pricked up their ears to listen to his Nobel Prize-level research.

Zhang Lin chuckled again: "Let me make this clear first, I discovered this research topic, you can't steal it, you have to respect intellectual property rights."

Those around him looked on with disdain. Zhang Lin coughed and said, "Professor, my discovery is this: we can adjust our breathing by using different hand gestures. For example, right now I'm making a circular hand gesture with my right thumb and forefinger. At this time, it's chest breathing. Then I change to a circular hand gesture with my thumb and ring finger, and chest breathing immediately becomes abdominal breathing. When you switch between the two hand gestures, the way you breathe also changes. It's amazing! I have a feeling that cultivating immortality might be real. You see, cultivating immortality requires using these hand gestures."

Song Ziming almost vomited up the milk tea that Gang had drunk. Really?
He did it immediately, and the others followed suit.

Holy crap! This is real! Real hand gestures that control breathing! What's the principle behind this? Everyone look at Zhang Lin.

Zhang Lin raised his head: "If I could understand the basic principles behind this, maybe I could crack the secrets of cultivation. Wouldn't you say that's Nobel Prize-worthy?"

(End of this chapter)