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EDITORIAL |
| Department of Cardiovascular Surgery Centre Hospitalier Universitaire Vaudois Lausanne, Switzerland |
In July 1799 in the small village of Rosetta (Rashid) in the western delta of the Nile, French soldiers of the Napoleon troops, who were demolishing ancient structures to build a fort, found a compact slab of black basalt with inscriptions in 2 languages (Egyptian and Greek) written in 3 scripts: hieroglyphic, demotic, and Greek. When the Rosetta Stone was carved, in 196 BC, these 3 scripts were being used in Egypt: hieroglyphic was used in official and religious documents, demotic was the everyday script of Egypt, and Greek was the language of the Egyptian rulers at that time. A group of priests in Egypt wrote the text of the Rosetta Stone to honor the Egyptian pharaoh Ptolemaios V in all 3 scripts so that priests, government officials, and the rulers of Egypt could read what it said: a list of good deeds that the pharaoh had done for the priests and the people of Egypt.
Despite hundreds of years spent deciphering hieroglyphs, the ability to read hieroglyphic inscriptions on monuments and tombs as well as papyrus texts written with cursive scripts such as demotic was lost in Egypt until 1822. The representation of a single text in 3 script variants enabled French scholar Jean François Champollion (1790–1832) to decipher hieroglyphs in 1822. Champollion could read both Greek and Coptic, the language of Christian descendants of ancient Egyptians. By analyzing the text of the Rosetta Stone and a copy of a bilingual inscription in hieroglyphs and Greek from the Bankes obelisk, he was able to figure out 7 demotic signs in Coptic. He then worked out what they represented by examining how they were used in Coptic. He began tracing these demotic signs back to hieroglyphic signs. After deciphering some of the hieroglyphs, Champollion could make educated guesses about the other hieroglyphs.
The Rosetta Stone represents a crucial breakthrough in the research of Egyptian hieroglyphs: the "translation" of silent symbols into a living language, which is necessary for communicating the information contained in these symbols. A similar process occurs in cardiac surgery, where the "translation" into the language of scientific communication (
everyday language) makes possible the continual two-way exchange between the problems arising daily in clinical practice ( hieroglyphics) and the potential solutions proposed by research ( language of the rulers).
CLINICAL PRACTICE
Despite tremendous advancement in cardiac surgery, the list of problems that crop up daily in clinical practice is endless: myocardial and systemic damages induced by ischemia–reperfusion or hypoxia–reoxygenation, heart failure, hypertrophy, restenosis, tissue degeneration, organ rejection, inflammatory reaction to cardiopulmonary bypass, late referrals, multiorgan failure, and so forth. Clinical solutions currently available for these problems generally provide results that are suboptimal, if not completely disappointing. When the results are un-satisfactory, cardiac surgeons turn to research to look for an interpretation of the problems they cannot control, for a better understanding of the underlying congenital defect or acquired abnormality, or for potentially improved surgical management of the condition.
RESEARCH
Merriam-Webster's Collegiate Dictionary defines research as "investigation or experimentation aimed at the discovery and interpretation of facts, revision of accepted theories or areas in the light of new facts, or practical application of such new or revised theories or laws." Traditionally, this definition includes areas where knowledge is incomplete and where further research is needed.
The development of cardiovascular surgery in the past depended on substantial animal experiments, and surgical researchers often borrowed basic knowledge and methodology from physiology. However, great break-throughs in surgical techniques always were achieved with original ideas and innovative methods introduced by surgeons. Research in basic science was traditionally carried out at academic medical centers in "wet lab-oratories." New surgical techniques were designed, cardiopulmonary bypass refined, and clinical concepts validated in animal laboratories. In recent years, this type of animal research, particularly with large animals, has substantially diminished — almost disappeared. Much of the recent research in cardiac surgery is driven by the explosion of new biology that many in the field have little or no familiarity with, such as cellular, molecular, and genetic biology. Experimental research has turned to molecular biology more than descriptive physiology has, and new treatments involve gene therapy and bio-engineering more than they involve surgical techniques. This situation has created a new generation of surgical scientists, a new environment for the performance of such research, and a new language.
SCIENTIFIC COMMUNICATION
The communication of new scientific knowledge, traditionally limited to specialized journals, meetings, and workshops, faces 2 major challenges in recent years: the exponential growth of knowledge and computer technology. Information and computer technology has given unlimited access to knowledge, which itself has become as important as its acquisition. With Web-based technology, educational content can be presented in a variety of formats, enhancing the content and making it available beyond the traditional confines. As wireless technology evolves, information will be available at the patient's bedside through handheld devices. Often, in the past, the two-way exchange between basic science and clinical applications is blocked and set back by psycholo-gical barriers, lack of communication between experimental innovators and clinicians, and insufficient international distribution of new knowledge. The collaboration between basic and clinical research is now more intense than ever because the rewards for science that has potential clinical applicability tend to be greater.
The safe and effective translation of these multidisciplinary efforts into clinical practice requires careful evaluation by highly trained clinical investigators. This translational research is the clinical research of the future, and it has enormous potential. New approaches and competencies will be required of the next generation of researchers, who, more than ever, will need to be conversant with diverse scientific disciplines and be able to collaborate with experts in these disciplines. Further progress in cardiovascular surgery will continue to be made possible on the basis of animal experimentation. Clinical investigators are uniquely positioned to translate basic research advances into clinically meaningful progress. The best link between clinical practice and the new biology is cardiac surgical scientists exposed to current information, who, like the Rosetta Stone, can interpret clinical problems and the new knowledge provided by basic research, thanks to modern scientific communication.
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