Chapter 363 - 248: One Man, An Army

It was time. The conference began.

The session chair, a professor from the United Kingdom, walked onto the stage and said:

"Good morning, colleagues."

"Welcome to Turner Hall at Johns Hopkins University. Today's symposium will focus on the latest advancements in gastroenterology and hepatobiliary surgery. According to the rules, each presenter will have fifteen minutes to speak, followed by a ten-minute question-and-answer, or Q&A, session. Please raise your hand to ask a question, and state your name and affiliation after you receive the microphone. Now, let us proceed to the first topic."

He looked down at his note card. "Please welcome our representative from Ruijin Hospital in China, Dr. Wen Xuyang, who will present a report on the clinical data for gut microbiota intervention in hepatic encephalopathy."

Applause broke out.

Wen Xuyang took a deep breath and stood up.

As he passed Jiang He, their eyes met. He read the message in Jiang He's look: *Go get 'em.*

'Yeah. I've got this!'

After getting on stage and setting up his PowerPoint, Wen Xuyang adjusted his breathing and began:

"Good morning, esteemed experts. I am Wen Xuyang, representing Professor Li Jianping's team from Ruijin Hospital."

"Hepatic encephalopathy is a common and severe complication of end-stage liver disease. Current treatments primarily involve the combined use of lactulose and antibiotics. However, our team has observed in clinical practice that interventions targeting the gut microbiota show significant individual variability among specific populations…"

It was all thanks to Jiang He helping him iron out the logic of his presentation in the executive lounge last night.

Now, his train of thought was crystal clear.

The more smoothly he spoke, the more his confidence grew, which in turn made his delivery even smoother.

'A perfect positive feedback loop!'

"This is the sample data we collected from 200 individuals of Asian descent. As you can see, in this model, we've introduced a multivariate adjustment specific to the high-carbohydrate, high-fiber dietary structure common in Asian populations."

"Journal reviewers have noted that our sample lacks global diversity. However, we argue that it is precisely this regional specificity in dietary structure and gut microbiota distribution that makes our model indispensable for interventions targeting Asian, and even East Asian, populations."

After he said this, several scholars in the audience nodded slightly.

He timed his fifteen minutes perfectly.

As the final "Thank you" slide appeared, Wen Xuyang lowered the laser pointer.

"That concludes my presentation. Thank you for your attention."

Applause filled the hall once again, this time much more enthusiastic than at the beginning.

Several scholars from Europe were whispering amongst themselves, clearly expressing their approval of the report.

A sense of accomplishment washed over Wen Xuyang.

He looked toward the area where the delegation from China was seated and smiled at Jiang He.

The three senior professors, Zhou Deming, Fu Yunshu, and Guo Fengwan, also nodded slightly, their expressions filled with relief and pride.

On a top-tier international academic stage like this, for a scholar from China to present their research findings so completely and confidently was a victory in itself.

The session chair gestured to the audience, indicating that it was time for questions.

In the first row, slightly to the left, Dr. Hayes raised his hand.

A staff member quickly passed him a microphone.

Hayes stood up and said politely:

"Thank you, Professor Wen, for your wonderful and very insightful presentation. I'm Hayes, from the Department of Surgery here at Hopkins. I have a small question regarding your basic statistics."

"You mentioned that you used a multivariate adjustment for Asian dietary structures. However, in your Spearman correlation analysis, I didn't see any stratified weighting for the patients' baseline hepatic reserve function—their Child-Pugh class—across the different dietary subgroups. If the baseline differences in the liver's own metabolic clearance rate were ignored when establishing the targets for microbiota intervention, could we not then suggest that your positive results are simply a reflection of the self-healing tendency in patients with compensated liver function, rather than the actual effect of your intervention?"

Wen Xuyang's mind raced. "Dr. Hayes, regarding that point, we performed a strict screening for the Child-Pugh class during enrollment, focusing primarily on Class B and Class C patients. In our regression model, the baseline liver function is treated as a default controlled variable…"

Hayes: "Pardon the interruption."

According to the conference rules, a speaker should not be interrupted while answering a question.

The session chair on the stage frowned slightly. He reached for his microphone to intervene, but after seeing Miller, who was next to Hayes, give a slight shake of the head, he pulled his hand back and remained silent.

Hayes smiled and continued into the microphone, "In rigorous statistical validation, 'default controlled' is hardly a persuasive term. Of course, I'm not questioning your conclusion. I just feel that before arriving at such a groundbreaking assertion, the demonstration process could perhaps be a bit more thorough."

Hayes sat down.

Before Wen Xuyang could even organize his thoughts, Dr. Carter raised his hand.

"Hello, Professor Wen. I'm Carter, also from Hopkins."

Carter spoke much faster than Hayes and used a great deal of complex medical terminology:

"Following up on Dr. Hayes's line of thought, I'd like to discuss your OTU clustering criteria for the 16S rRNA sequencing. On slide twelve of your presentation, regarding the determination of abundance changes in *Bifidobacterium*, you set the homology threshold at 97%. However, in a consensus paper published last year in *Gastroenterology*, it is recommended that for patients with severe liver disease and altered intestinal permeability, this threshold should be increased to 99% to exclude interference from endotoxemia. Did you use a lower standard because the laboratories in your country lack the necessary sequencing depth, or was it a compromise to more easily obtain a statistically significant result?"