A surgeon who will work here start from today onwards,
Asada Ryuutarou.
If this hospital is closed,
There will be a lot of patients who can't be saved.
That's why, I've come back here.
I want to entrust my hospital to you.
I will gather those doctors who agree with Sakurai-sensei's ideal.
The best team.
Let me pull 100% of my capabilities as you promised.
I'll give my best in order to save patients' life.
I come to make that kind of hospital together with Asada.
There's no reason to leave from here now.
I've been in charged of a girl who suffers from dilated cardiomyopathy.
There will appear in front of them ,patients who can't be treated with their equipment in that hospital anyhow, won't they?
At that time, absolutely give them a cooperation.
I guess that means exchanging conditions. Having them go to India.
As expected from the famous economic consultant in the world. Mr. Okamura.
I'm becoming an ally, because I want you to keep your promise.
I will give team Dragon to you anyway.
The artists have assembled, huh?
It's been a while,
Team Dragon
Looks like team Dragon has united at last.
However, there's still a missing piece.
They said that somehow he has been doing an interesting research?
Yes.
A treatment using a regenerative medicine to cure dilated cardiomyopathy,
Dilated cardiomyopathy: a disease of the heart muscle, primarily affecting your heart's main pumping chamber (left ventricle).
It's the most advanced medical treatment even when you look at it internationally.
As expected, it seems that he won't be able to continue the research if he moves to Sakurai Hospital.
The most advanced medical treatment in the world. That means he is the artist that needed most for our plan.
Yes. However, until the research is succeed,
Fujiyoushi-sensei can't be separated from that patient.
A patient, right?
Perhaps, that patient might bring him to us.
Yes, it's Regenerative Medicine Laboratory.
All right, please send me around the factor marker analysis.
Ok, I will send it.
Fujiyoushi-sensei, a phone call for you. Ah, Ok.
Yes, It's Fujiyoushi.
Is that so? You guys will do it again together?
Yeah. Everyone has come to Sakurai Hospital.
They have decided to go as long as there is somewhere worth going, even if throwing away the environment blessed with money and honor.
How about your patient?
The liver congestion has began to appear recently.
Cardiac function is worsening more than I thought.
It would be fine if she can undergo the surgery... However, it will be a very difficult state.
Fujiyoushi-sensei's research is amazing, isn't it?
Huh? Fujiyoushi is also a member of team Dragon.
In other words, my disciple.
According to this regenerative medicine, if the new approach is succeed, surgery might become unnecessary.
How to cure without doing a surgery?
Myocardial sheet. Cultivating the skeletal myoblasts which are included in the muscle taken from patient's thigh.
In short, making a sheet which has the same features as the heart muscle.
It's a mechanism which seems to improve the cardiac function of the patient's himself, If you put it on the surface of the damaged heart muscle.
Haha... There's no way that thigh will become a heart...
Unlike transplantation, it will hardly cause a rejection because it's patient's own cells,
The burden of patient's body is also much fewer comparing to surgery.
It's a revolution in the heart diseases treatment.
Revolution?
That things will be unnecessary if there's my god hand.
The surgery and also team dragon,
The day that become the relic of the past might be close, huh?
When will the myocardial sheet be able to be used?
Two years is the earliest until the authorization be granted.
Will you wait until that time?
I also have issued the application for approval to America's FDA.
It will be depended on the last situation, I might also have to think about heart transplantation in America.
Is that so? Please tell me if there's something anytime.
Ok. Bye.
Yes. Got it. I'll go there soon.
What's the matter? Sensei.
Saturations won't go up. Ambree.
Ok. It's okay, sensei has come.
Kana.
I will put in the medicine, okay?
Ok. Shall we change her oxygen mask?
Ok.
Heart failure is advancing and her condition is worsening.
How long does it takes to wait for your myocardial sheet to possibly be used?
Is there no any other way?
If myocardial sheet is useless, how about surgery?
Doing an emergency surgery in such condition, the risk is too high.
A surgery which takes a long time to a small body like Kana's...
Then what should we do?
Does Kana have no choice but continue to suffer just like this?
Fuyoushi-sensei's patient seems to be a 6 years old girl.
Sakurai General Hospital - Medical Office
Perhaps it's the same case that occurred to his late daughter.
We've done taking the CT. Ok.
There will be a appendicitis surgery at 3 o'clock.
Please also confirm it to Arase-sensei.
I understand.
Sensei!
Yes, It's L&P ER. 60-year-old man.
Has been complaining of chest pain and nausea. Is it possible to accept?
Our first aid rooms are full right now because of the critically ill patients. Refuse it!
I'm sorry, right now is a kinda... Please accept.
Huh? How's the bleeding?
It's cardiovascular surgical department. Huh? What?
ER asks to take over a patient.
Why should we take ER's patient?
Looks like the staffs are having their hands full.
I will refuse it, since it's 5 o'clock already. No, no...I'll take it over..
It's Kihara, chief of surgical department.
If you have it unmanageable, then it's better not accept it in the first place.
so who's messing around like that... Newly appointed director of ER?
Hayakawa, you shouldn't go home first while I was talking on the phone.
Cardiovascular is not ER's subcontract.
After entering the front entrance, then properly went through the procedures. Do not only examine the patients.
Geez.... Oh, It fell off.
Ah, I'm sorry. Sorry.
Be careful. I'm sorry.
Geez.. What's with this?
It's so naive. Transferring ER's patient to cardiovascular department.
Please. Passing through the stretcher.
Wait!
Excuse me. Wai...
It's Kihara, Chief of surgical department. Doctor of cardiovascular, right?
Please help the patient over there. ST Elevation of aVR.
aVR (Aortic valve replacement): a procedure in which a patient's failing aortic valve is replaced with an artificial heart valve. The aortic valve can be affected by a range of diseases.
There's a possibility of triple vessel disease. Applying a surgery....
What's with deciding on your own?
Even if you say so, the operation room is not vacant right?
If the operation room is unavailable, it's ok to do it with catheter, isn't it?
Kitou. Sensei, why you are here?
There's no need to explain it to you.
Bring him to the cath lab quickly.
The schedule of cath lab is also full. Tourniquet 200.
Ok.
At this time, extracerebral cath lab is vacant, right?
But... Well...
Aren't you being ignored? Surgical Department Chief.
Heparin 5,000 IV Ok.
What will you do if there's a malpractice by doing this kind of method?
Malpractice won't be happened.
As long as there is me, okay? Line, quickly!
Can't secured the line ! Place the central.
Ok!
The acceptance rate of ER has raised 30% in a week after you come, sensei.
In ER, we take a precise judgment, after that distribute to the specialist.
The result of having adopted your suggested 'gateway' system has appeared immediately.
ER is patients' 'gateway', and becomes the entrance.
Patients who enter from the entrance later will be hospitalized in L&P.
L&P will be able to gain new patients since they will visit the hospital. It will also leads to the stabilization of the management.
It wouldn't be a bad discussion to anyone.
We can not let all patients be troubled
by ruining the hospital with such method that ignores profits.
Yeah, as expected from a hospital management specialist.
As for Kitou-sensei who has understood that the medical care is not a charity work. I think it's the real integrated medical.
because of that reason, I've chosen you.
Indeed, 82 years old Chateau Garda is different, right?
Does it suit to your taste? Yes, I like it.
A taste that suits for celebrating a success, huh?
Because it's a big step for us.
The Prime Minister also said with a complete agreement that he want us to proceed in medical zone concept immediately.
Being careful in new medicine examination is good,
However because of that, Japan's medical care is falling behind the world-class which is fatal as a business, isn't it?
Yes.
If it takes a long time to be recognized by the clinical trials,
An outstanding research also will be scooped by the other countries before it's being put on a practical use.
By having the medical zone been approved,
If we can also have the medical treatment that hasn't been authorized in Japan in the medical trial exceptionally,
our country's medical care will move forward massively, don't you agree?
It's fine to think that here isn't in Japan any longer.
Fujiyoushi-sensei.
As soon as the myocardial sheet's approval is received,
Cell cultivation has been done before so that the medical trials can be started immediately.
However, there's a possibility that patient's heart won't wait until that step.
Is that the reason why you came here?
Until myocardial sheet will be able to be used,
I want to keep that weakened heart, somehow.
BNP has rising up to 900 pg/m.
There isn't much time to spare, is it?
EF also has been cut to 20%.
At this stage, time for the heart-lung machine to be put will be limited.
I guess it's not an easy surgery.
It's not easy but it's not impossible either.
If it's this team.
The first treatment choice is transplantation. If the donor appears..
Ijyuuin, you do the transplanting surgery. What?!
Regarding the heart transplantation, Ijyuuin, proud of the number of top classed domestic cases right now. He's the perfect choice.
But, the children donor are somehow..
If the donor doesn't show up, we'll do the left ventricular plasty.
But, right ventricular pressure is risen and TR also has begin to move up.
To say that it's enlarging, it's a heart of six years old girl.
If it's too small, the blood pressure won't be released.
Then it won't be able to be gone down from the heart lung machine.
We'll use sizer this time.
There won't be any trouble if we stitch up while doing the sizing.
Is that so?
Ventricular assist device might be needed after surgery temporarily.
I'll arrange for it.
Although it's a surgery that other doctors won't do, right?
Well.. If I'm doing the anesthetic, I will raise the success rate by 10%.
It's alright until the myocardial sheet will be able to be used.
Please keep it somehow till then.
Only to you guys, this surgery can be entrusted to.
We'll give our best.
There's one problem.
This hospital's equipment is not enough if there'll be an emergency surgery.
At least, PCPS and the approval of Bud for backup are needed, aren't they?
Three-dimensional evaluations by 3D CT and 3D Echo are also needed.
We won't be able to do the right sizing without an accurate preoperative examination.
It means that it's impossible to do in here, isn't it?
Only there.
Team dragon has come bringing a patient?
It's faster than we thought.
The chance has jumped in from the other side.
Seems to be Fujiyoushi-sensei's patient.
It's an awesome hospital, isn't it?
There's no environment that has been set just with this most advanced equipment like this even in our country.
Doctors who will do the surgery are...
They are surgeons that I trust most.
If it's like that, I guess it will be alright.
It's good right, Kana? Yes.
Looks like that team dragon will come, won't they?
What?
Seems like they will do a dilated cardiomyopathy surgery for children at ours.
Why you know it first than me the chief of surgical department?
You name wasn't in there.
Have you been graduated from team dragon?
Uhmm... I.... I...Uhmm?I will supervise.
We'll be able to see the surgery of the rumored team dragon, right?
Yes.
You guys, open your eyes and see that team dragon's surgery that I will supervised....
Will Fujiyoushi-sensei's research be in time?
We wouldn't know their greatness if we only watch it once.
It's too early, you would understand their greatness after the 2nd one.
He's Asada-sensei, the surgeon. Please for your help.
So far, Asada-sensei is an excellent surgeon who has succeed great numbers of difficult children surgeries.
Kana will be saved, won't she? Yes.
Let's do our best together, okay? Ok.
Welcome to L&P Hospital, Doctor Asada.
Please allow me to introduce myself, I'm Okamura, L & P's management consultant.
I've heard the rumor about you.
Certainly, Sakurai Hospital is also reassured by the joining of Asada-sensei's team, isn't it?
That place is a hospital that must not be lost.
I think so too.
For that reason, we are willing to cooperate with Sakurai Hospital.
There are a lot of excellent specialists in our hospital,
In terms of the equipment, we are proud to be in the best five of our country.
It's the best environment to show Asada-sensei's skills, isn't it?
Please feel free to use anything that can be used.
I appreciate it.
Asada-sensei's most prominent operation techniques and the most advanced medical equipments are a marriage.
The highest grade of wine shows its true values because of being poured in a glass.
If the selection of the glass is wrong,
I guess it will only ruin the mellow taste of a valuable wine.
I'm just going to give my best for the patient right in front of me.
Giving the best for the patient right in front of you.
The best choice at this stage is overlapping.
Right. Yes.
The lead will be Katou.
2nd assistant will be Ijyuuin.
Please prepare the sizer. Ok.
I'll prepare for the best stage.
The operation will start tomorrow. January 15, 10 AM.
Considering the age of 6 years old patient, Estimated time to be finished is at 1 PM.
3 hours? Patient's heart won't wait if we take time more than that.
Leave it to us.
Ijyuuin, please make an artificial tendinous cord while I'm approaching the papillary muscle.
Ok. From the anterior papillary muscle, right?
For the pledges, I'll do it in a quarter.
How about the tricuspid valve? I'll do it with Kay method.
I guess that's the best way. I'll prepare the NO.
We must put the PA line in.
Yes.
How about the mitral valve regurgitation?
Mitral valve regurgitation: happens when your heart's mitral valve doesn't close tightly, which allows blood to flow backward in your heart.
Prosthetic valve replacement can't be done since she's still a kid.
Ring also can't be used. Use self-pericardium.
How about biventricular pacing? It's better if it's there.
I'll prepare for it.
What is it? Ah, I'm sorry.
It's nostalgic because it seems that the old Sakurai Hospital is back.
the old time, you mean time when Asada was here?
Every night until late at night, giving the best for the patients,
Everyone engaged in a discussion just like this.
I will preserve the Adam Cue Bits in the artificial blood vessel replacement.
Drainage of the spinal cord is also needed.
Yes. Have the heart-lung machine circulate in a half flow.
It's impossible in half flow.
The bloodstream in renal artery is important.
Don't hesitate to circulate it in a full flow!
Director... Director... But...
I guess in order not to be left behind, I will do the simulation properly.
We'll save the patient no matter what it takes.
Can't sleep?
You don't have to worry.
Because Asada-sensei is the best doctor.
The best? Yes, the best in the world.
Then... Kana can go to elementary school?
You can.
Absolutely? Yes, absolutely.
Surely you will also make a lot of friends. Thanks God...
That's why please don't worry and have some rest.
Ok. Goodnight. Ok. Goodnight.
As expected, an excellent management consultant.
What are you talking about?
Making that patient as a gateway for team Dragon to step into L&P.
However, they don't know yet what's exactly inside that entrance.
Team Dragon's belief is to give the best for the patients right in front of them.
I'm just cooperating on that.
I'm praying for the success of the operation.
Hello.
It's about the time for tomorrow..
Tomorrow?
Aah, you forget it as expected... Preview of the wedding hall.
Ah, sorry. Tomorrow I accidentally have a serious operation.
Operation?
If we don't do it, the patient might not be saved. It's a serious operation.
Is that so? Well I guess there's no other way.
I trust Ijyuuin. Also there are lots of patients who come to Meishin.
Ah, yes.
Ok then, I'll go there alone tomorrow.
Do your best for the operation, ok?
Thank you. I'll call you again.
Fujiyoushi-sensei. The detailed examination result is out.
This is..?
Asada!
The operation is canceled.
The operation is canceled, what does it mean?
HIT has been detected in the detailed examination result.
HIT. Heparin-induced thrombocytopenia.
HIT: development of thrombocytopenia (a low platelet count), due to the administration of various forms of heparin, an anticoagulant. HIT is caused by the formation of abnormal antibodies that activate platelets
Heparin can't be used.
The heart-lung machine won't be able to circulate because the heparin can't be used.
If the heart-lung machine can't be used with this heart's condition,
The operation is impossible. Unable to operate?
Argatroban: a direct thrombin inhibitor approved for the treatment of heparin-induced thrombocytopenia (HIT) type II. Argatroban is predominantly metabolized in the liver.
How about the argatroban?
Patient has start to show a heart congestion symptom due to her heart failure.
Then it can't be used, right?
Because the liver will be metabolized by argatroban, right?
If we stick to the myocardial sheet method,
The treatment can be done without giving a heparin.
But the approval of myocardial sheet hasn't been given!
Can't we do something?
Please give me a break!
Why should I lend it to a person who has resigned from Meishin?
A patient's life is depending on that.
If it gets caught, it will be my responsibility!
Sorry. Wait!
I'll be responsible for that.
The surgery can't be done?
In a surgery, in order to stop the activity of the heart with anesthetic, we connect it to the heart-lung machine.
At that time, we use a medicine called heparin which prevents blood coagulations.
However, from the detailed examination result,
We knew that Kana can't take that heparin.
What?
In short, since the heart-lung machine can't be circulated, the surgery can't be done.
It's a lie, isn't it? Then how about Kana?
But didn't you said that you will cure her.... and it's going to be alright, did you?
Are those all lies?
I'm really sorry.
Is it really impossible? Is there nothing you can do?
There's the most advanced equipment in Japan, isn't it?
There are many difficult operations that has been succeed, aren't they?
Please. Please save Kana.
Unfortunately with this condition the operation...
Can't be done.
I'm sorry.
It can't be... Isn't that different from what you said before?
Are you giving up on Kana?
She said that she will be able to go to school because a great doctor will operate her.
She's looking forward for it.
Please do something. You're the best in the world, aren't you?
Why? Why is it impossible?
Are you, Fujiyoushi-sensei?
We are doing a careful examination regarding the myocardial sheet's clinical trial...
Then it won't be in time...
A patient unable to be operated because of HIT. That's why we could only rely on the myocardial sheet.
The approval of the clinical trial takes some times because we need to make sure for its safety.
If we can't use myocardial sheet now, there will be a patient who will lose her life...
If it's failed, there is a possibility that the study of regenerative medicine would fall behind 10 years or 20 years because of it.
If that happens, nobody will regret for that one patient who can't be saved, right?
Life is a life even if it's just one person !
It's time for the other appointment, so excuse me.
There's no more time. I beg you.
Please wait !
It was unexpected even for you?
It's impossible to say that it was HIT...
Fujiyoushi-sensei's Myocardial Sheet can't be used yet.
It's unfortunate, isn't it? Even how much effort to put up by team Dragon, there is...
The operation can't be done. If the myocardial sheet can't be used,
Then I guess they can't do anything,
For the school bag, I think chocolate is nice...
Ah, but pink is also nice... Mom, which one do you think is nicer?
Well...
and then, after I become an elementary school student, I'll make a lot of friends...
When the school is finished, I want to play tag with everyone at the park.
That would be great...
Can I ask my friend to come to our house too?
Let's go home, dad !
Mom, Please help for everyone's snacks..
I'll go to America.
Has the approval of the myocardial sheet been granted?
No. But it's more likely to be faster than Japan.
Kana's myocardial sheet has been completed already.
I'm intending to proceed the preparation, so that we can do the treatment as soon as the approval is granted.
Is that so?
The schedule for patient to be called will be two weeks after.
I'm counting on you while I'm not here,
Ok. I'll definitely cure her and come back home.
Fujiyoushi.
What?
It's bad! It's bad!
Kihara! Sensei!
Sudden mitral regurgitation has occurred.
Mitral regurgitation? It's ruptured chordae tendineae of the mitral valve.
Ruptured chordae tendineae can only be cure with surgery. However, the surgery is impossible.
If the torn chordae can't be repaired,
Myocardial sheet also can't be used. Sensei... Kana....
Sensei, please save Kana. Please.. I'll do anything.
What will you do, Asada? It will be cardiac arrest if it's like this.