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DOUBLE-BLINDED MEDICINE: When Doctor and Patient Are Both in the Dark

DOUBLE-BLINDED MEDICINE:

When Doctor and Patient Are

Both in the Dark

I met a dermatologist the other day who made my skin crawl. He was in his thirties, tall, lean, and unsmiling, like many doctors these days. But what stood out most was a fresh-looking, full-color, eye-popping tattoo on his right arm that snaked its way up from his wrist, circumvented his forearm, and slipped beneath his short-sleeved shirt to unknown anatomical areas. I believe he also had a tattoo on his left arm, but I was too gobsmacked at the time to take note.

Now, you might think, as I do, that a tattooed dermatologist is an oxymoron. It doesn’t take much imagination, or research on the Internet, to realize that tattoos are bad for the skin.

The most obvious issue is that tattooing is done by puncturing the skin, causing skin trauma and risk of infection. Interestingly, there is research that connects the injury to the skin made by both tattooing and vaccinations as a cause of numerous skin reactions, including cancer.

The 2014 article, “Tattoo and vaccination sites: Possible nest for opportunistic infections, tumors, and dysimmune reactions”, in the journal Clinical Dermatology, explains that, “Both dermal tattoos and vaccine injections may alter local immune responses, creating an immunocompromised district on or near the site of placement. This can lead to the development of opportunistic infections, benign and malignant tumors, and local dysimmune reactions… A variety of tumors including basal and squamous cell carcinomas, keratoacanthomas, and malignant melanoma also have been reported in association with tattoos… Vaccination sites similarly provide a setting for both benign and malignant tumors.”

The inks used are also a problem, causing allergies and exposure to heavy metals. It is fairly common for individuals to have an allergic reaction to the dyes used in tattoos. Ink is actually filled with many chemicals and unnatural ingredients that can irritate a person’s skin.

There is also a link to skin cancer. When it comes to cancer, black ink can be especially dangerous because it contains a very high level of benzo(a)pyrene. Benzo(a)pyrene is currently listed as a carcinogen by the International Agency for Research on Cancer (IARC). Black ink is the most commonly used color for tattooing.

You might think that this doctor may have gotten his tattoos before becoming a doctor, so he didn’t know any better. But this was a new tattoo. And he was flaunting it, not hiding it.

Tattoos are common these days, and fashionable in certain circles. Doctors want to look cool, like everyone else. They grew up like everyone else, exposed to, and brainwashed by, the same cultural messages. They just choose to go into medicine.

I also met a cardiologist who smoked cigarettes. He was also grossly overweight, and ate a big, juicy hamburger with fries for lunch. Of course, being obese, smoking and eating fried foods can increase heart disease.

An obese, smoking cardiologist eating fast food makes as much sense as a tattooed dermatologist.

Maybe these doctors are attracted to their specialties because they know they will need treatment from that specialty due to their lifestyles? It’s like when mentally-disturbed, neurotic people become psychologists or psychiatrists.

How about female doctors who constrict their breasts with tight bras for long hours daily? There are many female breast health experts, including breast surgeons, who wear breast-harming bras. Their medical training never mentioned tight clothing as a cause of circulatory impairment and lymph stasis. These doctors willingly immobilize and alter their breast shape, hide their nipples, and basically re-design their breast appearance for cultural reasons, and do this despite the documented harms caused by bras, including causing breast pain, cysts, and cancer. Wearing bras is just something every woman is culturally expected to do, even doctors.

Is this hypocrisy? Should we expect doctors to be paragons of health and healthy lifestyles?

More basically, when we seek help, does it matter whether the helper is in the same mess we are in? In other words, can you trust a lifeline from someone in the same boat as you?

We seek help in many places.

Would you go to a priest who was a known pedophile?

Would you use a mechanic whose car is broken down?

Would you go to a hairdresser who is having a “bad hair day”?

Would you use a plastic surgeon who has a big nose, cock-eyed chin, and facial scars?

How about eating in a restaurant where the cook is out because of food poisoning?

You could also go into a health food store and buy chips, coffee, candy, wine, beer, and lots of other unhealthy stuff.

Then there are the drug addiction recovery programs that offer coffee to everyone, one of the most addictive substances we consume.

Clearly, there’s a problem here. We live in a culture where there are lots of products and activities that can harm us. In fact, the biggest cause of disease and death is the culture and all the bad things it teaches us to think, do and feel. We absorb these cultural messages from the uterus onward, as our nature becomes modified by our culture.

This applies to everyone. It includes doctors, too. Just because someone studied medicine, it does not mean that they personally eliminated all harmful cultural practices in their lives. The same cultural causes of disease that fill their waiting rooms also fill their personal lives. In fact, the medical culture is even worse on doctors.

For some reason that is not clear, the medical system exploits doctors with long work hours and sleepless day and night shifts. Doctors are rushed and pressured, grabbing unhealthy snacks on the go. They become tempted to abuse drugs to keep going, but may settle for drinking 10-20 cups of strong coffee, instead. They also become tempted to use drugs to relax, but may settle for a few alcoholic drinks. They have little recreation time, or time with their families. And depending on their specialty, they are exposed daily to infectious diseases, death, radiation, the soul-robbing sights and smells of hospitals, and the depression of treating endless lines of sick people, often using treatments that do no good, and for conditions that have no known cause.

Clearly, being a doctor can make you sick, mentally and physically. No wonder why there are so many doctor suicides. Just practicing medicine is slow suicide.

This also means that doctors are not the ones to tell patients to clean up their lifestyles. The doctor’s lifestyle is at least as bad, and actually worse. They participate in the same unhealthy culture as everyone else, addicted to many of the same things, and suffering from the same psychological and physical issues. But they are the ones who are meant to treat those problems.

The Present and Future of Radiotherapy

The radiotherapy market is growing due to several factors, such as an increase in the number of new cancer cases and technological advancement in the hardware and software used in radiotherapy. The current international markets are underequipped to address new cases of cancer. In low- and middle-income countries, only 10% of the population has access to radiotherapy. Therefore, there exists a wide gap between the demand and the installed base of equipment, which offers a huge opportunity for the companies to grow in the radiotherapy market. Expansion of the radiotherapy market can be both lifesaving and profitable.

Effective planning for the treatment

It is necessary, and continuous technological developments are taking place to minimize the exposure to radiation of healthy tissue, in order to avoid any side effect. This goal is a driving force of R&D for radiotherapy. Software plays an increasingly significant role in cancer care. Population growth and increased life expectancy are adding to the incidences of cancer. The software & services segment includes software, which is used for treatment planning, analysis, and services, which are needed for the maintenance and efficient use of radiotherapy devices. The software & services segment of the companies are expected to grow, as software products help improve physician engagement and clinical knowledge-sharing, patient care management, and the management of cancer clinics, radiotherapy centers, and oncology practices for better performance. Companies like Varian are continuously increasing their software portfolio. Software plays an increasingly significant role in cancer care. At the same time, healthcare systems are subject to harsh budgetary constraints in nearly every country. As a result, healthcare providers face the challenge of achieving more while using fewer resources. To achieve this goal, hospitals have a strong need for software platforms that make radiotherapy treatment cost-effective. The development of effective software will improve the delivery of advanced radiotherapy in the future.

Introduction of new technology
Technology is another salient feature. Radiation therapy remains a significant modality for cancer treatment, which is the primary driving factor for the designing of new techniques to improve the survival rate of cancer patients. New technologies, like proton beam therapy, are available in developed countries like the United States, Germany, and United Kingdom, due to well-established reimbursement policies. Proton therapy can be used on tissues that are highly sensitive, like brain, spine, and eye tumors. It is more accurate, as compared to other X-ray radiation therapies.

Advancement in the technology is also helping to execute the planning of the radiation therapy.

Technological advancement in existing technologies, such as CT imaging, is making imaging more accurate and consistent. This can give a better representation of a tumor and help in better planning. Already-existing technology, such as IMRT, SBRT, IGRT, conformal 3D, VMAT, and others that are used for radiation therapy treatment is undergoing various advancements. For example, Varian is developing a software, which can be used to develop better planning tools, in which statistical models can be used to calculate the quality of an IMRT treatment for a patient. This is expected to increase the usage of IMRT for treating cancer. IGRT is the type of radiotherapy. Research is more focused on IGRT, in order to prove its fewer side-effects. IGRT may include electronic portal imaging, fluoroscopy, ultrasound, CT scan reconstruction, and respiratory gating technology. SBRT is also growing as an option for treating cancer. SBRT is used to escalate the dose to the targeted tumor, which can increase local control while limiting the dose to nearby critical structures and normal tissues. This will cause minimum damage to the surrounding tissues and hence, will experience strong growth in the forecast period.

A Healthy Dose of Medicine for the Soul

A large segment of the human population takes things way too seriously for their own good. The strange anomaly is that most people laugh at the wrong thing and fail to laugh at the right thing. This serious incongruity has robbed people of a healthy attitude towards life in general.

Those who take life too seriously are in danger of missing the great joys of living in a crazy world like ours. I am not sure about the scientific research but I would guess that for every sad moment it takes one hundred laughs to balance the books. Some people are about ninety-nine laughs short of a real sane moment.

I like the old English proverb that says, “Laugh and the whole world laughs with you, cry and you cry alone.”

From my perspective, if you cannot laugh with someone you will not be able to cry with him or her and have it mean anything.

According to some medical advice, it takes more facial muscles and energy to frown than it does to smile. Of course, the only exercise some people have is frowning and who am I to take that away from them.

I am determined, no matter what, to exercise my right to smile and laugh and enjoy the world around me. I must confess that I get this attitude quite honestly.

My paternal grandfather was a Past Master in the area of practical jokes. No amount of time was too much to spend preparing for one of his famous practical jokes. His favorite holiday was April 1 and began preparing for this holiday right after Christmas.

The fact that his practical jokes at times got him into trouble did not seem to affect him at all.

Once while in the hospital for an extended period he had somebody smuggle in to him a can of snuff. For some reason he liked chewing snuff. It is the most disgusting habit I know of on earth.

He no sooner received his smuggled goods then he began chewing it. If you know anything about chewing snuff, you know it is accompanied by a lot of spitting. As usual, his timing was impeccable. Just as the head nurse passed his door and looked in, he leaned over and spit in to the garbage can he had next to his bed. The nurse, not knowing about the chewing snuff, thought he was spitting blood and immediately went into emergency mode. Immediately my grandfather was rushed into the operating room and the surgeon and medical team were assembled.

My grandfather was very sick at the time. Some did not think he would get out of the hospital.

Just as they got him situated in the operating room he pulled from under his sheet his can of chewing snuff and smiled at them. The only person in the room that thought this was in any way amusing was my grandfather. The doctors were so angry with him that they refused to see him for three days and confiscated his can of chewing snuff.

My aunt and uncle lived right next to my grandfather. My aunt was hyper clean when it came to her house. Dirt in any form was not welcome under her roof. She had a broom that was always within reach because she never knew when a piece of dirt would try to invade her domicile.

That year my grandfather found something new. I am not sure where he found it but he probably spent a lot of time looking for something like this. It was a rubber facsimile of a very nasty looking piece of vomit. To him it was a prized possession.

Most of his practical jokes were executed on April 1. Whenever we saw grandfather coming on this particular day we usually ran for cover.

He went over to visit my aunt and was sitting on the couch in the living room. They chatted for a little while and then my grandfather began to cough a little bit. He said to my aunt, “I haven’t been feeling good lately. I really don’t know what it is.” Then he started to cough a little more seriously, to which, my aunt got up and went to the kitchen to get him a glass of water thinking that might help him.

When she got back, she was shocked to see on her new coffee table a very horrible sight. My grandfather was bent over the coffee table hacking and coughing as though he was in the process of dying. On the coffee table was a very nasty looking piece of vomit.

My aunt went into hysterics. She whirled around and within a moment had grabbed her broom and started towards my grandfather. My grandfather was laughing but not for long.

Suddenly he realized that the flailing broom in my aunt’s hand was aimed at him. She chased him out of the house, down the driveway and for at least three blocks yelling obscenities at him that I dare not repeat in public society.

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Importance of Right Glassware

Eating and drinking may be just another imperative thing to do for humans for their survival, but they are impacted by a lot of things. One of the factors that has a direct effect on the manner in which the food is targeted and absorbed by the body is the psychology with which one consumes their food and drinks and this psychology is majorly affected by the cutlery and the utensils in which we do this repetitive task. Eating proper is not just about eating the right food in the right manner, but it is also about eating it in the right kind of dishes. The plates and glass in front of us can either make or kill the mood to eat food (no matter how good it is or how well it has been cooked). For example, a normal steel plate can be an immediate mood killer as compared to one made out of some great quality glass. Same goes for the glasses; be it for drinking water, serving alcohol to guests, or just gulping down some wine or beer when you are in the mood.

The entire paragraph can be paraphrased to basically say that the crockery, cutlery, and glasses used for food intake should be swanky and attractive to not only make the food look more good and presentable, but also to add a touch of chic and décor to your kitchen and also leave a good impression on the guests (if and when they come).

BUYING THE RIGHT TYPE OF GLASS DISHES

So far we saw how the type of dishes used can be a buzzkill for many which is why in all sorts of setups (be it your home or a professional environment such as a restaurant or a bar, etc.), following are some factors that one may consider in order to ensure that your crockery and glass dishes always appear at their best:

If plates are the concerned department, it is best advised to stay simple yet elegant and the best way to do so is to go with plain white plates reason being that they are conveniently inexpensive, present the food in the best manner possible, and also do not fade away easily.

For wine glasses, it always suggested to go with those that have a relatively sturdy build to them for them slipping away from your or your guests’ hands are always a great flight risk not worth taking.

For red wine, go with glasses with a wide bowl
For white wine, go with a glass that has a comparatively narrow bowl

Chemistry teaches us that “symmetry leads to stability” and the same should be applied to your crockery. The balance between normal and ornate design plates should be perfect.

For champagne and martini and other types of alcohol glasses, there is no fixed trend you can follow. There are quite a bunch of options to choose from depending upon the alcohol and your taste and preference when it comes to your glassware. For example, the champagne flute is the most common champagne glass, the brandy balloon is the most common glass used to serve brandy, etc.

Cancer Immunotherapy Use on Cancer Patients

Recent advances in treating cancer patients have resulted in the development of biological therapies that can prove to be a promising alternative to conventional cancer therapies. Immunotherapy harnesses the body’s immune system to identify and fight effectively against cancer cells.

Immunotherapy works by attacking the growth of cancer cells or stimulating the immune system to kill cancer cells. Contradictory to the standard cancer treatment regimes such as chemotherapy, radiation therapy, which act on both normal and cancerous cells, immuno-therapeutic treatments are highly specific. A wide range of cancer immuno-therapy approaches exists such as immune checkpoint blockers, cancer vaccines, immune-modulators, monoclonal antibodies and cell based immuno-therapies have demonstrated to be effective against cancer patients.

The most commonly targeted form of cancer chemotherapy is the use of monoclonal antibodies as they can be tailor-made in the laboratory. They have unique antigen specificity thereby allowing themselves to attach to specific epitopes on cancer cells. This flags the cancer cells and makes it more visible to the immune system so that it can find and destroy those cells. Currently, most of the monoclonal antibodies are undergoing phase 3 clinical trials or awaiting FDA review process. Unlike monoclonal antibodies, non-specific immuno-therapy approaches such as administration of immuno-modulatory cytokines are also being used to treat melanoma. Cytokines are hormones that are endogenously produced by the body to enhance or suppress T-cell response against cancer cells. IFN-α and IL-2 are most commonly characterized cytokines used in cancer immuno-therapy.

The primary cell-based immuno-therapy strategy which is successful these days is the use of T-cell therapy, wherein cancer T cells removed from blood are modified with chimeric antigen receptor (CAR) and is then infused back into the patients to treat metastatic cancer. Another form of cell-based immuno-therapy used is tumor-infiltrating lymphocytes (TIL) therapy, wherein TIL is surgically removed from tumor tissue and is considerably increased in the laboratory by adding cytokines to it and is then re-infused back into the patient.

A promising treatment that has emerged in recent times for treatment of melanoma is the use of immune checkpoint inhibitors. They act by inhibiting the checkpoint receptors on T cells that act as brakes to the immune system thereby mediating anti-tumor responses. Some of the commonly used antibody inhibitors that have been commercialized are PD-1, PDL-1, and CTLA-4. Another more focused approach to cancer immuno-therapy is the use of vaccines to encourage the immune system to generate antibodies that can target tumor specific antigens, thereby eradicating cancerous cells. Cancer vaccines include peptide-based, dendritic cell-based, tumor cell-based and DNA cell based. Cancer vaccines can be broadly classified as preventive or therapeutic. Preventive vaccines are commercially available for against cervical and liver cancer causing viruses such as human Papillomavirus and Hepatitis B virus, respectively.

However, in spite of these advances, limitation such as tumor heterogeneity, unpredictable efficacy and identification of potential markers still exist in the field of cancer immuno-therapy. Therefore, new more targeted cancer immuno-therapies and preventive strategies are being developed and tested, which will deliver novel efficacious therapy against relapsed or refractory cancer patients.

Cardiac Diagnosis Support By Global Air Ambulance Services In Allahabad With Medical Faculty

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Analysis to Next Generation Sequencing Technology

With the development of science, traditional Sanger sequencing has failed to meet new requirements of low cost, high throughput and fast in speed.

Recent years, with the discovery and promotion of second-generation sequencing technology, the gene sequencing speed has increased greatly while achieving a substantial decline in costs, making large-scale application of genome sequencing possible. Now, the cost of personal whole genome sequencing is about 5,000$, and is expected to decreased to less than $ 1,000 in the next few years.

The rapid development of sequencing technology will promote the massive accumulation of DNA sequencing data, accompanied by the accumulation of the corresponding individual diseases, signs and other data at the same time. When we accumulate enough data, how to understand these data will be critical. On the micro level, generations of molecular biologists’ studying the effects of apparent biological traits genes exert on utilizing technologies like gene knockout have made breakthroughs in many crucial aspects. On the macro level, statistics and other data analysis techniques are introduced to study the relationship between gene sequences and biological phenotype. The accumulation of basic scientific research gradually brings breakthroughs in clinical applications.

There are now two types of clinical applications mainly, one aims at disease screening of ordinary people. It infers people’s future risks of getting cancer by measuring the known genes associated with a disease loci. The other aims at the diagnosis cancer and other deadly diseases. It finds in a series of drugs or plans the most effective one for certain patients by testing the loci of certain genes.

Data from BBC research shows that total global gene sequencing market increased from $ 7.941million in 2007 to $ 4.5 billion in 2013, and will reach $ 11.7 billion in the year of 2018 with the CAGR up to 21.2%.

Currently, the market of de novo sequence platform is mainly taken by several major manufacturers, including the Illumina, Ion Torrent / Life Technologies (was the acquisition of Thermo Fisher in 2014), 454 Life Sciences / Roche, etc.

Under such a circumstance, the next generation sequencing technology (second-generation sequencing) appears. As an emerging industry, the next-generation sequencing technology can be applied in clinical testing like antibody discovery, health industry, industrial and agricultural use of gene-oriented study as well as scientific research and development.

Discussion on Cell Therapy From The Point of Standardization, Scale, and Industrialization

What is cell therapy?
Cell therapy refers to the transplantation or input of normal or bioengineered human cells into a patient’s body and newly-imported cells can replace damaged cells or involve a stronger immune killing function, so as to achieve the purpose of treating diseases. Cell therapy has shown higher application value in the treatment of cancer, hematological diseases, cardiovascular diseases, diabetes, Alzheimer’s disease etc. In general, cell therapy includes tumor cell immunotherapy and stem cell therapy. There are two cell sources for cell therapy, one from the patient itself and the other from the allogeneic tissue.

The Defects of Cell Therapy
The cell is the most basic unit that contributes to a living organism, however, it does not mean that everyone shares the same cells. On the contrary, there is a huge difference in each individual which can be compared to human-to-human differences, that is, two identical people never exist. The huge difference between cells and cell preparations is the biggest drawback of cell therapy. In this post, we will discuss several issues that need attention in the current stage of cell therapy.

Difficulties in the Standardization of Cell Therapy
Cancer cell immunotherapy cannot be standardized from the stage of raw material acquisition. The cell treatment materiasl for each paitient are their own blood leukocytes. The condition and physical condition of each patient are different, and the collected white blood cell growth quantity and kill activity are not uniform and cannot be standardized. As it is impossible to standardize raw materials, preparation processes, and product specifications, it cannot be standardized, industrialized, and scaled up. Each tumor cell immunotherapy laboratory meets the GMP level with the hardware environment, and it can be more like a cell preparation workshop. Researchers ranged in number from a few to a dozen and could not really meet the standards of division of labor of industrialized pharmaceutical companies. Taking stem cell therapy that using umbilical cord mesenchymal stem cells as an example, which raw material is an umbilical cord, and one umbilical cord-produced cell can be utilized by many paitients. The standardization path is more advanced than the immunotherapy of tumor cells, and the raw materials can be standardized to some extent.

Difficulties in The Scale of Cell Therapy Industry
At present, the production mode of the cell therapy industry mainly depends on technicians. In the 10,000-grade clean laboratory, the cells are operated in class 100 clean bench, cultured in a carbon dioxide incubator, centrifuged in a centrifuge, observed through an inverted microscope, and the drug reagents are stored in a medicine refrigerator. All of these devices are operated by independent biological laboratories of the individual and being linked together through the operations of scientists. This type of production model is small in scale and similar to workshop-type production. Although there are some large scales, the essence is a collection of many small workshops. Due to the small scale, the instruments used are laboratory instruments and many of the reagents used are scientific reagents, which will lead to the issue of low efficiency but high cost.

Autologous or Allogeneic
There are two kinds of cell sources for cell therapy, one from the patients and the other from the allogeneic tissue. Autologous cell therapy cannot be standardized from the raw material acquisition stage, and it are only applied to the patient itself, the essence is essentially medical technology. The prevalence of autologous cell therapy as a medical technology is mainly due to the scale of the predicament. Allogeneic therapy, the cells derived from allogeneic. Taking tumor cell immunotherapy as an example, the cell source may be from cord blood, and the larger-scale cell source may be a filter plate for leukocyte filtration at the blood bank. Taking umbilical cord mesenchymal stem as an example, the cell source is the umbilical cord, and one umbilical cord-producing cell can be used by more than one person. If scale can be cultivated, although the quality standards cannot be quantified well, the scaled products themselves have a certain degree of standardized properties.

The cell industry, as an industry, is not the path to the advancement of cell-based therapeutics. If the advanced technology cannot be mass-produced on a large scale, it can only stay in the laboratory and become the object of research for scientists, never have achance to become a drug into the majority of patients. For allogeneic cell therapy that using allogeneic cells as raw materials, the standardized properties of the scaled products can be realized if large-scale cultures are prepared, then scale and standardization can promote each other. The current progress in standardization of cells is not easy, but the progress in scale should be relatively easy to achieve.

Natural cytokine supernatants with more standardized and standardized properties
Cytokines are a class of small molecule proteins with broad biological activity synthesized and secreted by immune cells (such as monocytes, macrophages, T cells, B cells, NK cells, etc.) and certain non-immune cells (endothelial cells, epidermal cells, fibroblasts, etc.) Immune responses are regulated by binding to the respective receptors to regulate cell growth, differentiation and effects. Cytokines (CK) are low-molecular-weight soluble proteins that are produced by various types of cells induced by immunogens, mitogens, or other stimulants. They have the ability to regulate innate immunity [1] and adaptive immunity [2], hematopoiesis, cell growth, and damage tissue repair and other functions.

Cytokines can be divided into interleukins, interferons, tumor necrosis factor superfamily, colony stimulating factors, chemokines, growth factors etc. Cytokines form a very complex cytokine regulatory network in the body and participate in many important physiological functions of the human body. Where stem cells and immune cells cannot reach the body, cytokines can easily reach target tissue sites because of their small size.

In recent years, recombinant gene cytokines have made remarkable achievements in clinical applications as a novel biological response modifier. A large part of the effects of stem cell therapy and immune therapy arises from the action of cytokines secreted in the body. The stem cells and immune cells in the body are introduced back into the body to secrete a variety of natural structural cytokines. Although the amount of these cytokines is relatively small, they are synergistic and act directly on the cytokine network in the body because of their high natural structure activity, lack of antigenicity but diversity. Because of the standardization, standardization, industrialization, and scale of natural compound cytokines, it is more cost-effective than cell therapy, allowing more patients in need to enjoy cell-like therapeutic effects.

Although natural complex cytokines can largely replace cell therapy, but there are still conditions that require the presence of cells to exert a therapeutic effect. We hope that cell therapy can break the current situation, become high efficiency and low cost with large scale, more standardization, and then be applied to more disease treatments.