Everywhere we have been to has become something of the past, no matter how green the mountain, how clear the water, and how tender the wind. Excessive lingering could turn out to fetter not only our feet but also our future.—I Love Starting (Guozheng Wang)
No. 1 Tower, 639 Manufacturing Bureau Road, Shanghai.
This is the most conspicuous building in the entrance to Shanghai Ninth People’s Hospital (Figure 1), and it accommodates oral clinics, surgical rehabilitation facilities, and outpatient surgery rooms. The time-honored building has witnessed the burgeoning history of oral and maxillofacial surgery in China, as well as the arduous efforts made by generations of medical staff in the hospital.
Prof. Zhiyuan Zhang, who turned 68 not long ago, has spent 44 years in the hospital (Figure 2).
Prof. Zhang is the longest-serving (15 years) director at the hospital and the second member of the Chinese Academy of Engineering in the specialty of oral and maxillofacial surgery. His office is on the fourth floor of the building, next to a ward and not far from outpatient surgery rooms.
Professor Zhiyuan Zhang, Academician of Chinese Academy of Engineering, Distinguished Professor of Shanghai Jiao Tong University, chief surgeon and doctoral supervisor.
From 1998 to 2014, he was the dean of Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. At present, he is the Academic Leader of Department of Oral and Maxillofacial Surgery, which is one of the National Key Disciplines. He is also the director of National Clinical Medical Research Center for Dental Disease, the director of National Research Center of Clinical Medicine for Oral Disease and Shanghai Key Lab of Stomatology. Currently, he serves as Honorary Chairman of Chinese Stomatological Association, Standing Council Member of Chinese Anti-cancer Association, Honorary Director of Head and Neck Tumor Committee, Fellowship of Royal Dental School of Edinburgh (UK), Fellow of the International College of Dentists, Honorary Fellow of College of Dental Surgeons, Hong Kong University, as well as Honorary Professor of Osaka Dental University in Japan and the Fourth Military Medical University in China. Meanwhile, Professor Zhang is the Editor-in-Chief of Shanghai Journal of Stomatology, and the Editor-in-Chief of state-compiled textbooks of oral and maxillofacial surgery.
Professor Zhang specializes in clinical and basic research of oral and maxillofacial-head and neck tumors as well as hemangiomas and vascular malformations. He authors 323 articles as the first author or the corresponding author, 113 of which have been indexed in SCI. Particularly, Prof. Zhang successfully carried out the first prospective clinical trial of neoadjuvant chemotherapy in oral cancer in China. These findings were published in well-known academic journals, such as J Clin Oncol, Cancer Research, Oncotarget and Carcinogenesis. He is also the editor of 13 monographs, associate editor of 5 monographs, and co-author of 12 monographs (2 in English).
He has been awarded 19 research grants at national, provincial and ministerial level, including one National “863” Project, one National Key Technology Research and Development Project for the 11th Five-year Plan, two key projects from National Natural Science Foundation of China and five grants from National Natural Science Foundation. The honors and awards he has received include Second Prize for Science and Technology Advancement by Chinese Government (twice), First Prize for Science and Technology Advancement by Shanghai Municipal Government (twice), Second Prize of the National Science & Technology Award Nominated by Chinese Ministry of Education, First Prize of Shanghai Medical Science and Technology Advancement, Third Prize of Chinese Medical Science and Technology Award.
His work has been recognized by Award of Outstanding Young Expert conferred by the Chinese Ministry of Health, Medical Sciences and Materia Medica Prize of Ho Leung Ho Lee Foundation, Outstanding Worker of National Science and Technology, Ten Elite Scholars of Shanghai Science and Technology. Six students have completed their postdoctoral research under his supervision, and fifty-five have received their doctoral degree, fifteen have received their master degree.
That’s just one of the many unconventional steps.
His life has always been unconventional.
Due to the “Cultural Revolution,” Zhiyuan Zhang had thought he would be doomed to be a farmer for life. Fortunately, in 1972 he was enrolled into the Department of Stomatology, the Second Medical College of Shanghai. Thanks to his outstanding academic performance, after graduation he was recruited by Shanghai Ninth People’s Hospital and assigned to work at the Department of Oral and Maxillofacial Surgery.
The hospital offered him a rare opportunity of promotion to a higher position in 1986, but he declined and was determined to get a master degree from Prof. Weiliu Qiu, a founding figure of oral and maxillofacial surgery in China. He was 36, the oldest student of Prof. Qiu.
He did not take the college entrance examination, and he had to learn English from scratch. In the daytime, he had to see patients and perform surgeries, and in the evening, he read books and learned English. Finally, he passed the entrance examinations for postgraduate applicants and completed the challenging tasks given by his mentor. With the instructions of Prof. Qiu, he created a new therapy to treat arteriovenous malformations in the oral and maxillofacial regions.
In 2015, Zhiyuan Zhang was elected into the Chinese Academy of Engineering and became the fourth CAE member in the hospital (Predecessors are Disheng Zhang, Weiliu Qiu, Kerong Dai). He is also one of the two living CAE members in the field of stomatology. His life has been marked by a successful and remarkable transition from a farmer to a college graduate and a hospital president, a leader of national key discipline, and a CAE member.
Prof. Zhang is almost 70 now, but he remains deeply committed to China’s development of oral and maxillofacial surgery and the hospital’s progressive transition into a research-oriented medical institution. To that end, he joined hands with AME to publish the Frontiers of Oral and Maxillofacial Medicine (FOMM) and played an essential role as a facilitator and pusher.
His contributions illustrate unequivocally why the journal is so significant and why it has to be published.
Six factors behind the successful launch of FOMM
In the opinion of Prof. Zhang (Figure 3), the history of medical science is divided into five stages of development—experience-based medicine, evidence-based medicine, translational medicine, precision medicine, and integrative medicine. At any stage of development, “conducting scientific research and writing academic articles are the top priorities.”
Before 2019, the Ninth Hospital had been issuing two journals—Shanghai Journal of Stomatology (established in 1992) and China Journal of Oral and Maxillofacial Surgery (established in 2002). But Prof. Zhang always has an unfulfilled dream—publishing an independent English-language journal.
After three decades of preparations, now it’s time to bear fruit.
“After persistent dedications of our founders, including Xize Zhang, Disheng Zhang and Weiliu Qiu, the hospital’s Department of Oral and Maxillofacial Surgery have established fame at home and abroad. The younger generations should keep up the good work and make new achievements.” As a connecting link between the preceding and the following generations, Prof. Zhang was emotional, “after three decades of unwavering efforts; we see a little glimpse of hope.” He believed six factors were behind the successful launch of FOMM.
First of all, in the past, when Chinese researchers made discoveries and wanted to share with others, their first choice was to send papers to western journals. We made significant and influential studies but gave them to foreigners for free. The situation needs to change immediately.
Second, China has a massive population of patients with all kinds of diseases, and that is the world’s most extensive library of patient samples. According to the national healthcare reform plan, patients are supposed to seek help at community clinics for minor illnesses, and they will be transferred to large hospitals if their conditions are severe. Large hospitals are supposed to be research-oriented and do exploratory research based on abundant patient resources so that more patients can benefit.
Third, FOMM will prompt young doctors to pay more considerable attention to scientific research, instead of being contented as surgeons. Essentially, a surgeon is no different to a carpenter or a bricklayer. The country has spent a lot of money and resources to cultivate a medical specialist with a master or doctor degree, and performing surgeries is not supposed to be their entire work. Instead, we should find problems during clinic practices and resolve these problems through scientific research. This is the only way to advance medical science.
Fourth, the Ninth Hospital is a national-level clinical medical center and has a key laboratory in Shanghai. “Innovation” should be a pivotal driving force behind research and clinical practices in the hospital. This journal will drive innovation at the hospital so that it can improve diagnosis and treatment and bring more benefits to patients.
Fifth, academic articles are an important means of promoting and applying research achievements. In the Internet era, it’s easy and convenient to acquire knowledge, like watching teaching videos and academic reports. But it’s always important to read and write essays. For instance, when we talk about a research topic, we have to read at least 100 academic articles in the field, but not necessarily 100 teaching videos.
Sixth, publishing an English-language journal is a reliable indicator of a hospital’s research capacity. How can we determine whether a research-oriented hospital lives up to its reputation? This is a crucial factor.
“Running an academic journal is not a single move. It requires persistent efforts by several generations. We are not in a hurry; we have to be patient.” Said Prof. Zhang.
Old bull in the northern latitude of 31 degree
Dating back to 52 years ago, Zhiyuan Zhang, a farmer at that time, would never have anticipated that someday he could become China’s second academician in the specialty of oral and maxillofacial surgery, and the tenth academician born in Wujiang, a district of Suzhou City in Jiangsu Province (Figure 4).
Zhiyuan Zhang was born on May 2, 1951, at the northern latitude of 31 degrees. His birthplace Wujiang was in the intersection of Jiangsu, Zhejiang, and Shanghai.
“Up in heaven, there is a paradise. Down on earth, there are Suzhou and Hangzhou. In the middle, there is Wujiang.” The so-called land of fish and rice has a profound history and culture and is home to a large number of well-known historical figures like Yazi Liu, as well as ten members of the Chinese Academy of Engineering and the Chinese Academy of Sciences. Among them are prominent figures like Jiachi Yang and Kaijia Cheng, both of whom were remembered for their contributions to the successful development of the atomic bomb, the hydrogen bomb, and the artificial satellite.
Due to the “Cultural Revolution,” Zhiyuan Zhang echoed the government call to work in rural areas and became a farmer after graduation from middle school in 1967. Many people of his age were frustrated because they were unable to continue the study, but he wasn’t. In retrospect of the days in the countryside, Zhiyuan Zhang said the spirit of hard work and perseverance was the most valuable assets for him, “it’s something you can’t learn in the classroom, it’s valuable practical experience.” At that time, he was secretary of a village’s youth league committee and an accountant. “He has a spirit like a bull. He can be a good farmer, and he also can be a good student”, according to some people who spent the time in the countryside with him.
“People born in the 1950s were growing up along with the republic and sharing the same fate, and we have a natural sense of patriotism and mission. In the meantime, since they had missed the valuable time of learning in the early years, they were later more cherished with the rare time in the school.” In 1972, Zhiyuan Zhang was admitted to the Second Medical College of Shanghai. Being aware of his weakness in academic knowledge, he had a strong sense of urgency and studied extremely arduous in the college.
During the ten years at the college and later as a resident doctor, Zhiyuan Zhang had left almost all footsteps at three places—staff canteen, operating rooms, and inpatient wards. He had never been to Shanghai’s famous attractions like the Huaihai Road and the Bund. Like a sapling deeply rooted in the fertile soil, he was seizing every opportunity to absorb the priceless nutrition. “I was given the rare opportunity to become a doctor and regain the lost learning opportunity; I have to seize it. In school, I was like a hungry and thirsty man.”
When recalling the seven years of life as a surgeon, Zhiyuan Zhang described his feelings as “fortunate.” “For me, the titles of hospital president, key discipline leader, and academician are based on the role of a surgeon.” During the seven years, he spent almost every hour in the operating rooms and wards, except eating and sleeping. He was taking care of a dozen hospitalized patients and was immediately available when any patient needed emergency care in the evening, even though he was asked to be an assistant. He can perform surgeries with both hands, but he said the skill is anything but a surprise—“the surgeon and assistants are standing at fixed positions during the surgery; if you can do the surgery with both hands, you can avoid some troubles, for instance, when performing a skin flap surgery.”
Zhiyuan Zhang was not contended to be a surgeon. In a hospital with a wealth of talents, he had hard feelings about missing the best opportunity to further study. He hoped to become a “qualified” leader. At that time, the hospital’s Party Secretary was about to retire, and he floated the idea of promoting Zhiyuan Zhang to be Deputy Party Secretary and director of Party Committee Office so that someday Zhang could take over his role. This was a crucial choice for the 34-year-old doctor.
Despite the Party Secretary’s praise, it is apparent that he is still far from a genuinely qualified leader. “Even if I take over this post, I would be unable to convince others because of insufficient knowledge and strength.” These years of study and practice with Prof. Weiliu Qiu and other senior mentors have motivated him to follow Prof. Qiu and further his studies.
Many people attempted to persuade him to drop the plan of further study, saying the promotion is a shortcut to the political arena, and it’s not worthwhile to spend the time in the university. At this time, his “bull strength” came up again: “Sometimes I have to stick to my point of view, it’s not bull spirit, it’s a little bull temper.”
The 34-year-old doctor was supposed to become the hospital’s Party Secretary and have a bright future in the political circle, but he finally chose to seek a master degree, do scientific research and overcome medical challenges. He has to hold not only the firm determination to start from scratch, but also figure out valuable learning time out of a large amount of clinical work every day. Because it was difficult to cut off the work on surgery and clinical practices, he could only study in the evening. It was not unusual for him to read a book in bed and stay awake until 2 A.M.
His mentor Prof. Qiu once commented on him: “Others are born calves who are not afraid of tigers. There is an old bull in our class who is also not afraid of tigers.” (Figure 5). The inadvertent words became the motto of the “old bull.” In 1986, Zhang passed the examination to become a postgraduate student of Prof. Qiu. Two years later, he graduated in advance with extraordinary results and continued to pursue a doctoral degree. The first research topic assigned by his mentor was to remove the considerable malformation of oral and maxillofacial arteries and veins. At that time, it was regarded as a forbidden area for surgery. Few people dared to resect tumors larger than ten centimeters. Patients had nothing to do but endure the endless pains. They could not sleep or eat, and abrupt bleeding could even cost their life. During the doctorate study, Zhiyuan Zhang performed surgeries in the daytime and plunged into the laboratory in the evening. Three years later, he finally created a “three in one” therapy for the disease, that is, “embolization + resection of lesion + plastic repair tissue.” The lesions were removed in one operation. With effective therapy, he eventually fulfilled the task assigned by his mentor.
“I return to my hometown today for two reasons. The first is to report my work results during these years, and the second is to express my gratitude to all teachers and fellow townsmen who have been helpful to me. I would not be who I am without your help.” After that, he made three bows to all teachers present.
This took place on January 2016, not long after he was elected to the CAE.
Lingpu Huang was Zhiyuan Zhang’s mathematics teacher in middle school. His cellphone has kept several text messages from Zhiyuan Zhang, some were blessings during holidays and festivals, and some were casual communications. At the end of every note, he would leave respectful words. “The student is very grateful. So many years after graduation, he has never forgotten his teachers”. Huang said in a proud and appreciative tone.
Other classmates also echoed the teacher’s praises. According to Yurong Shao, head of the class in middle school, Zhiyuan Zhang was not talkative, but he was friendly to classmates and very respectful to teachers. He is now thriving and well-known, but he remains nostalgic. He has tried to make time to attend parties arranged by classmates in the middle school; if he has no time, he will make sincere explanations. Once a teacher was hospitalized, he took good care of the teacher. His thoughtfulness touched everybody.
“He has always been hardworking, and his success is entirely credited on himself.” This is the consensus remark from his classmates.
Well-intended talent judge
“Far off the shore, the water is so blue, like the most beautiful cornflower, and is also clear, like a piece of bright glass. However, it’s so deep that no anchor chain can reach the bottom.”
This is a classic description in the book of “The Little Mermaid.” It can also be used to describe Prof. Zhang’s commitment to his students, as blue as the sea, but deeper.
“Academician Qiu has made unremitting efforts to build oral and maxillofacial surgery into a comprehensive, highly skilled and broad-ranging specialty by taking the road of integration, infiltration, absorption, and cooperation, and led a strong team to build oral and maxillofacial surgery into a new specialty with Chinese characteristics. Thanks to his contribution, China now has a position in the field on the international stage.” This is a comment made by Prof. Disheng Zhang, mentor of Prof. Qiu, CAE member and a founder of orthopedic surgery in China. As the student of Prof. Qiu, Prof. Zhang now takes over the baton from his mentor, and great responsibility means higher requirements for him.
As a student, he was always influenced by what he saw and heard from his teacher; as a teacher, he mentors students with his words and deeds. His words, deeds, and pertinent instructions have made up of the stories between him and his students.
“Telling young people about elusive dreams and aspirations will only make them more rebellious. Only by telling the examples that have happened around me will they be impressed.” Prof. Zhang believes that a teacher should resort to homeopathic induction, rather than force students to accept the hard truth. He also shared deadly stories about his teacher, Academician Disheng Zhang. During the Anti-Japanese War, Dr. Disheng Zhang was treating wounded soldiers on the battlefield. During his study of plastic and reconstructive surgery in the University of Pennsylvania, the Korean War broke out. He did not hesitate and decided to return to China and joined the medical team in the frontline of the war zone. He put his own life at risk, although he could have continued to stay in the U.S. to complete the study.
Also, he believes that setting an example is a more prominent means of education. When a mother always quarrels with others with her kid on the side, what a person will the child become in the future? Prof. Zhang said something enlightening for his whole life—what the teacher did to me; I do the same to my students.
He shared a little story. “A patient waited three hours to get the chance to see a well-known doctor, and another two hours to finally sit in front of the doctor. The diagnostic process lasted only three minutes. The patient filed a complaint, not because of the short process of diagnosis, but because the doctor did not even look at him during the three minutes.” No matter when he just became a doctor, or when he later became the hospital’s leader and an academician, Zhiyuan Zhang has always exchanged eye contact with the patients, used simple and understandable languages to tell them why they are sick, how to treat them and matters that require attention after recovery. “Put yourselves in the same position. If we go to see a doctor, what do we want to know? Then you tell patients what they want to know.” In his opinion, to gain trust from patients and recognition from peers, doctors’ “medical quotient” is as essential as “intelligence quotient.”
What Prof. Zhang said and did have left deep impressions on some 80 master and doctoral graduates, and they have repaid his painstaking efforts with excellent performance. They have won a good reputation among patients, and 17 students have received prominent titles such as National Outstanding Youngsters, Yangtze Scholar, Chief Scientist of Major Research and Development Projects of the Ministry of Science and Technology, Shanghai’s Young Talents of Science and Technology, winner of Shanghai Silver Snake Award, as well as doctoral instructors.
As a mentor, Prof. Zhang always says that a teacher should praise students in public, and point out their shortcomings in private. “Even he has only one merit, and the teacher should let others know in public; even he has only one shortcoming, the teacher should point out and heavily reprimand behind closed doors.” (Figure 6).
Facts prove that targeted education is beneficial.
Prof. Xinquan Jiang, a student of Prof. Zhang, is now a Yangtze Scholar and an outstanding national youngster. He still remembered how he was persuaded by Prof. Zhang to join his team. At that time, he had two career options. The first is to stay in Canada with advanced laboratory equipment and a prestigious mentor; the second is to return to China and conduct research in a newly-established small laboratory with simple equipment and only one experimenter. At home in Wuxi City, he welcomed an unexpected guest—his doctoral mentor Prof. Zhang. The visit has convinced him and his family members and reinforced his determination to stay in the hospital headed by Prof. Zhang. In the small and straightforward laboratory, he has produced a large number of significant research achievements (Figure 7).
A good judge of talents must have a pair of sharp eyes to identify who is competent and capable. During the preparations for FOMM publication, Prof. Zhang insisted that Zheng Jiawei is the best choice as the journal’s Editor-in-Chief. “When he was applying to be Prof. Qiu’s doctoral student in 1996, he had already published 156 academic articles. At that time, it was very productive.” Jiawei Zheng is now Executive Deputy Editor-in-Chief of Shanghai Journal of Stomatology and Editor-in-Chief of China Journal of Oral and Maxillofacial Surgery. “He has a good command of Chinese and English. With the same group of data, he can write a good article in a short period. More importantly, he is interested in reviewing academic articles. We need people like him.”
“We should let everybody display his talent so that everybody can make full use of his talent.” This is a comprehensive summarization of the “targeted education” strategy proposed by Prof. Zhang.
Set out to explore the unknown world
The only real paradise is the one that has already been lost. The only attractive world is the one that has yet to be explored.
Prof. Zhang has his idea about how to explore the unknown world.
The first is to “stand at a higher position.”
In 2008, Prof. Zhang led a research team to carry out a multi-center prospective study on individualized, sequential therapy of oral verrucous carcinoma and conducted China’s first randomized controlled trial on TPF-induced chemotherapy for advanced oral verrucous carcinoma. After five years of study, the research team made an important conclusion in 2013: there is no substantial difference in survival time between patients receiving induced chemotherapy combined with surgery and those undergoing surgery or radiotherapy alone. The study was selected as one of China’s top ten types of research in the field of clinical oncology in 2013, and was hailed by a commentary in the editorial of Oral Oncology as “one of the top six international clinical studies on head and neck diseases.” According to Prof. Zhang, the prospective study not only addressed a 50-year dispute about the effect of induced chemotherapy in mid and advanced-stage oral cancer, but also improved the international guidelines on oral cancer treatment, provided standardized therapy, and cultivated top stomatologists.
In response to the longstanding debate about why radiotherapy and chemotherapy would produce entirely different results on the same type of oral tumor, Prof. Zhang said that we have to conduct fundamental research on tumor and figure out if there is any problem with any biomarker. Only when you are standing at the peak of the mountain, you can think outside the box and see the problem from a comprehensive perspective. In 2014, Prof. Zhang stepped down as president of Shanghai Ninth People’s Hospital so that he could have more time for clinical practices and research. “Our goal is to build a national key laboratory on oral oncology, set up a biobank, and explore the sensitivity of cancer cells to different drugs and conduct study on combined and sequential therapy.”
Prof. Zhang is leading a team to make preliminary preparations for establishing China’s first PDX model for oral verrucous carcinoma, which will lay a solid foundation for large-scale clinical trials. “The biobank should be used along with clinical data. Otherwise, it’s empty talk.” The team has collected tumor tissues from patients and transplant into rats, and stable animal models can be built on the third generation of rats. The team has developed 62 PDX models. “It’s not an easy process. It takes three generations to build a PDX model, and one generation takes three months; that is nine months for a model. If the third generation of rats has genetic mutation from the original tumor tissues, the model will be deemed unsuccessful due to genetic alterations.”
The second is to “be farsighted.”
Shanghai Ninth People’s Hospital’s Department of Oral and Maxillofacial Surgery was certified in 2010 by IAOMS as a training base for international specialists. In 2014, the Royal College of Surgeons of Edinburgh awarded the department as China’s first head and neck tumor training center of oral and maxillofacial surgery. The two designations indicate that China has strong academic standing and impact on the international stage in the field of oral and maxillofacial surgery. “As a leader of the discipline, I think I can continue to work for another ten years.” (Figures 8,9).
Several pharmaceutical companies had requested cooperation after they learned that Prof. Zhang’s research team is building PDX models for oral verrucous carcinoma. “They said they would give us money as long as our PDX models are proven effective.” Prof. Zhang flatly rejected their offers. “We must be farsighted. We must not forget why we were building PDX models in the first place. To resolve the decades-old problems, we have to count on three factors—the advancement in genetic testing, the extraction of biological information, and big data analysis. The models are essential for us to figure out very valuable biomarkers for cancer patients.”
In 2016, Prof. Zhang’s team secured an RMB 55 million research project. The project was headed by his doctorate student, who was only 36 years old.
Under the guidance of Prof. Zhang, the “farsighted” team is braving the wind and waves toward a promising future.
So, where is the boundary between the past and the future?
It’s now, just at the very moment.
During the preparations for the launch of the FOMM journal (http://fomm.amegroups.com/), Prof. Zhang was nominated to be the Editor-in-Chief. However, like his mentor Prof. Qiu, he is more willing to be a guide. He encouraged the younger generation to assume significant roles, while he and his mentor can be Honorary Editor-in-Chief. “We two can provide you with strong support. You have to make a great journal, and make sure every article lives up to rigorous quality standards.”
Prof. Zhang now holds several prominent titles like hospital president, CAE academician, and key discipline leader, but he said surgeon is an eternal title for him. Sometimes he gave up a break in the noon and went straight into the operating room.
In the concluding remarks during the interview, Prof. Zhang said for a significant part of his life, he has been on the frontlines as a surgeon. He feels that the entire time has been “worthwhile.” (Figure 10).
We would like to express our sincerest gratitude to Prof. Zhiyuan Zhang for sharing his stories, insights and opinions with us.
Conflicts of Interest: The author has no conflicts of interest to declare.
(Science Editor: Lili Liao, FOMM, Email: firstname.lastname@example.org)
Cite this article as: Liao L. Prof. Zhiyuan Zhang: set off and swim against the stream—ambitions and aspirations. Front Oral Maxillofac Med 2019;1:4.