top student at medical school

Chapter 550 Even Routine Surgery Can Be Extraordinary (Please Subscribe)
"The Ilizarov technique is a classic orthopedic technique that has been used in our trauma surgery department for many years."

“Professor Fang, although our country currently has strict control over this technology and the selection of indications is becoming increasingly narrow, this patient is quite typical,” Professor Gong Jiahe said as he walked into the operating room.

The anesthesiologist team is currently administering continuous spinal anesthesia. This surgery will take a relatively long time, so spinal anesthesia is definitely not suitable.

It's either continuous spinal anesthesia or general anesthesia.

The Ilizarov technique, a theory of limb regeneration and functional reconstruction established in the 1950s, is widely recognized as the fourth milestone in modern orthopedic surgery.

It also has another name in China, called "bone-breaking height-increasing technique", and is currently listed as one of the "forbidden techniques".

Of course, no surgery is strictly prohibited. However, its indications will be narrowed considerably, and performing such surgery solely for the purpose of increasing height is illegal.

As early as 2006, the former Ministry of Health of China issued the "Notice on Strict Management of Limb Lengthening Surgery"!
The indications for limb lengthening surgery are clearly defined as bone defects or limb length discrepancies caused by congenital malformations, trauma, tumors, infections, etc., as well as limb deformities caused by diseases. Due to the significant trauma, numerous sequelae, high cost, and high risk of disability associated with this surgery, its use as a cosmetic procedure is strictly prohibited by the state!

It can be used for treatment, but not for cosmetic purposes; the purpose of height increase is for aesthetics. (Here, the author suggests that most people should avoid height-increasing surgery, because those who are capable of it won't do it, and most of those who do are not skilled enough!)

This patient was also a former member of the military.

During previous training, I contracted malignant osteomyelitis of the tibia, which shortened my lower limb by nearly 20 centimeters.

It's not that I haven't received treatment; after joining the military, all treatments were fully reimbursed. I could go to any place that offered treatment.

Not only military hospitals, but also external hospitals, all offer full reimbursement, but the final effect is still not obvious.

After being shortened by twenty centimeters, walking normally would undoubtedly be a nightmare.

Furthermore, the shortening of the length undoubtedly increases the difficulty of the surgery. Moreover, due to osteomyelitis, the patient also has other lingering problems, which makes many trauma surgeons unwilling to work on the patient again!
Nobody wants to cause trouble for themselves.

He could only try his luck at the corresponding medical institution in the military region, where he had previously continued with conservative treatment and sought out specialists for treatment.

Upon hearing this, Fang Ziye remarked, "Professor Gong, I have recently conducted a very detailed investigation of some materials."

"We also listed some options, but in the end we decided to use the classic technique!"

"The current development of osteotomy and orthopedic surgery does not support us in applying new methods."

“Professor Ilizarov is a genius doctor; he has practically exhausted decades of orthopedic techniques,” Fang Ziye said, adding.

"However, I have had some new insights while researching literature recently."

Fang Ziye's current level of basic theory in trauma surgery is level 6. At this level, he can gain new insights and his own understanding of any new theory he studies.

Because of his extensive knowledge, Fang Ziye also wrote down some of his insights.

If the surgery date hadn't been so close, Fang Ziye might have had other ideas. However, the patient didn't want to wait any longer. If there were classic surgical techniques available, a little minor innovation would suffice!
"Professor Ilizarov's greatest contribution should be the Tension Stress Law (LTS)!"

"When our biological tissues are slowly stretched, it stimulates tissue regeneration and active growth. This growth pattern allows for cell division, just like fetal tissue."

"Bone tissue, like epithelial tissue and connective tissue, has a very strong regenerative potential."

"The discovery that bones, attached muscles, fascia, blood vessels, and nerves can all grow synchronously is truly remarkable."

"Genius!!!" Professor Miyako exclaimed.

"However, while this technology may seem easy to implement, it is not easy to truly master it."

Professor Ilizarov's main contribution is not only the external fixator and the surgical technique, but more importantly, the fundamental principle he discovered, which can be said to be one of the cornerstones of modern osteotomy and orthopedics, making him a pioneer.

Fang Ziye said, "When I was at Zhongnan Hospital, I also encountered a case, but it was not as difficult as this surgery. His shortening was only eight centimeters, and he was relatively young."

"So about two years after the surgery, he recovered to his normal height. I estimate that this patient's postoperative recovery period may be six to seven years."

"During this period, the affected limb will still be shortened, and movement will be quite inconvenient."

As Fang Ziye spoke, he patted his legs with both hands.

Upon hearing this, Professor Gong Jiahe immediately laughed, placing his phone on the shelf as he said, "Professor Fang, this is what makes you so amazing."

"How did you come up with the idea of ​​creating a stress-resistant foot prosthesis before the patient's shortening problem was resolved?"

"Generally speaking, prosthetic limbs are mostly used for patients after amputation. Making a prosthesis for a healthy person to increase the stress on the affected limb is something that most people would not even dare to think about."

Upon hearing this, Fang Ziye's thoughts drifted slightly.

What else could he be thinking? It was something his seemingly taciturn and unremarkable advisor was thinking about when he had nothing to do, after his research career was ruined.

There were no "winners" in the passing of his mentor, Professor Chu. His mentor himself, needless to say, died unexpectedly.

His own teacher, Yuan Weihong, and several of his senior fellow students had all had difficult experiences.

Even Professor Dong Yaohui, who was the director at the time, had an unhappy experience afterward, which made Fang Ziye even more convinced that Dong Yaohui would only think of harming Professor Chu if he was out of his mind.

In Dong Yaohui's documents, even artificial intelligence prosthetics were considered, let alone a prosthetic for a normal person.
"I used to play on stilts when I was a child."

"Professor Gong, as you know, I am a native of Enshi. Ba County is mountainous. I remember it snowed often when I was a child. Back then, my family was not well-off, and it was very cold to walk on the ground in winter with shoes on."

“Going to and from school is not easy. We kids like to cut bamboo and make stilts, partly for fun and partly to make it easier to get around.”

"The ground becomes extremely muddy after it snows."

“Sometimes when I’m thinking about it, I start to think in that direction,” Fang Ziye replied.

Fang Ziye did not deliberately mention Professor Dong Yaohui. It was not that Fang Ziye wanted to take away his "thinking", but that there was no need to bring up his mentor when chatting with people.

When real results emerge, Fang Ziye will naturally include them as one of the contributors. I wonder if, currently, patent applications and published articles can include deceased individuals.

According to existing copyright law, the main focus is on the contributions of the participants, regardless of whether they are alive or not.

"Professor Fang is still young; his thinking is quite agile," Professor Gong Jiahe said.

"The anesthesia is complete, professors!" a doctor from the anesthesia team replied.

However, after saying that, he added, "If you can solve this patient's problem using a non-open surgical procedure, then you will truly have done a great service."

The Ilizarov external fixation technique can actually be performed non-invasively.

Its theoretical basis emphasizes that the surgery can effectively preserve local blood supply, periosteum and medullary canals, thereby promoting bone tissue formation.

Unlike traditional surgical methods, the Ilizarov method avoids complete open reduction during pinning and external fixation. Instead, it uses a semi-closed micro-incision to cut only the bone and cortex to correct and lengthen the bone's function.

Anesthesiologists may have seen this before, but this surgery is different from ordinary surgeries; it will still be performed via open surgery.

The above only refers to simple lower limb shortening deformity.

If the patient's knee joint is of equal length and it is tibial atrophy, it can be done without osteotomy. However, since the patient has shortening from the femur to the tibia, osteotomy and correction are required before 'bone transport' in order to design a good lower limb length ratio!

This technique is also one of the special bone transport techniques.

Upon hearing this, Fang Ziye said, "Teacher, you think too highly of me. If this patient could be cured with ordinary surgery, I would never have encountered him."

That's a humble statement, but not really humble at all.

"Hey, this young man has guts!"

"Alright, enough chit-chat, let's get to the surgery. Everything's ready here." The anesthesiology professor said, scanning Fang Ziye up and down.

Then he added in a low voice, "Professor Fang, have you ever thought about getting a new girlfriend?"

Fang Ziye had originally planned to go out to disinfect and wash his hands, but upon hearing this, he turned around quietly and gave him a pair of intriguing eyes.

The other person couldn't stand Fang Ziye's scrutinizing gaze and turned their head away first.

The people in the operating room pretended not to hear anything.

Actually, there are many people who have similar thoughts to him, but the difference is that this cunning old man said it out loud.

At the sink, Gu Yi and the others did not mention this matter.

Fang Ziye should handle matters of the heart himself; no one should interfere.

If Fang Ziye didn't have a girlfriend, that would be a different story.

After washing and disinfecting their hands and putting on sterile gowns, Gu Yi and Miao Haoyu had already completed the disinfection process.

Then the two of them put on sterile surgical gowns and stood properly in their assistant positions.

The three professors took the stage and occupied the positions of assistants, but there wasn't much they could actually help with.

Fang Ziye didn't waste any time with words. He simply picked up the scalpel and drove in cleanly and efficiently, making no obstacles along the way.

With a level 5 incision technique and a level 6 foundation in trauma surgery theory, Fang Ziye is more familiar with the approach to limb surgery than he is with his own home.

Inside the house, you might not be able to find many of the traditional Chinese medicine ingredients.

However, the incision Fang Ziye made was not large, only four centimeters. But it seemed that Fang Ziye had found the optimal gap in this four-centimeter incision. Along the way, apart from breaking through the skin and fat layer, all other parts were blunt penetrations.

In other words, Fang Ziye was already extremely skilled at controlling the incision!
The professors had seen this kind of wound before, but seeing it again still gave them a strange sense of refreshment, as if they were appreciating art.

"Comfortable," Professor Fang Zhikuan said simply, expressing his inner feelings.

He was usually the quietest person, but on the operating table, Fang Zhikuan was more likely to utter a few words of reflection.

Fang Ziye was pleased to hear Professor Fang Zhikuan's praise, but instead of chatting, he immediately picked up the bone knife.

"Bone lengthening surgery" is a prohibited procedure, but it is necessary for this patient, and bone grafting will also be required.

Otherwise, if his shortening is too long, it would be difficult to achieve a compensatory effect directly through the Ilizarov technique alone without causing a fracture.

After Fang Ziye made a window with a bone scalpel, he had the scrub nurse hand him a oscillating saw. He easily separated the bone and then moved to the lateral side of the lower leg to perform a simple and quick fibular pedicled bone flap removal procedure.

The fibula is a commonly used bone graft material!

In general surgery, the bone flap is at least three centimeters long to ensure that the segment has a blood supply. If it is too short, the nutrient vessels may be misaligned.

However, Fang Ziye did not do that. He only took a bone flap of about 0.5cm. After the oscillating saw cut the fibula again and took out the nourishing blood vessels along with it, the Gong family and the professors couldn't help but gasp.

The layman looks at the excitement and the insider looks at the doorway.

Harvesting bone flaps is not more difficult when the flap is longer; on the contrary, it is more difficult when the flap is shorter. The surgeon needs to be more careful and meticulous in controlling the surgical and anatomical location.

The greater the difficulty, the higher the difficulty.

For example, when you use chopsticks to pick up food, it's easy to pick up large chunks of food, but try picking up a single piece of meat stuck to the side of the bowl.

This is skill, this is foundation...

Strictly speaking, this surgery was not particularly difficult in terms of procedure or complexity. After discussion among Fang Ziye and others, it was reduced to a very simple and ordinary procedure.

One was a bone graft, and the other was the fixation with the external fixator from Ilizarov.

However, this approach has certainly been discussed by many people.

Their courage to do so stemmed from Fang Ziye's exceptionally strong foundation.

In ordinary patients, a longer bone graft might be better, but for this patient, who has no fractures or bone defects, a shorter graft is better.

This level of brevity is very difficult to control.

While it is possible to remove the pedicled bone after transplantation and then perform resection, how can you guarantee that you haven't affected the blood supply to the local bone?
If it can't be completely guaranteed, then the surgery will be much more difficult...

After carefully transplanting the bone flap to the fracture site, Fang Ziye tilted his head and asked, "Dr. Miao, can you perform this kind of deep vascular suturing with small windows?"

Within the group, Miao Haoyu has the best basic skills in suturing, while the others are all very "orthodox" trauma surgeons who only talk about trauma surgery techniques.

Miao Haoyu's skill in suturing, a standard basic skill in hand surgery, is not high. His level should be above level 4, but Fang Ziye has forgotten the original standard for the exact level.

Miao Haoyu looked at the incision and saw that it was only four centimeters long. After the muscle tissue was pulled, there was less than two centimeters of operating space left.

He shook his head decisively: "Professor Fang, why don't you go and do this? I can't handle it!"

Although Miao Haoyu knew that Fang Ziye was feeding him, he knew that given his limited abilities, he shouldn't be too ambitious.

They immediately admitted defeat.

Fang Ziye didn't force him; he picked up the small needle holder and tweezers for microsurgery and started working.

The space was narrow and the wound area was cramped, making it very difficult to operate!

If the basic suturing skills are not good enough, the difficulty of this operation under direct vision is comparable to climbing to the sky. Of course, the incision can be enlarged before suturing, but this will also increase the patient's wound area.

Fang Ziye also spent a bit of time, a full two minutes, before he could suture the blood vessels supplying the bone flap in place. Only after seeing a small amount of blood seeping from the broken ends of the bone flap did he nod in satisfaction.

“Professor Gong, you can insert the IUD. I’ll continue with the tibial side. Since we’ve chosen the simplest treatment method for this surgery, let’s try to save some time!” Fang Ziye said.

This is not the kind of ring commonly used in the general public; it is the Ilizarov adjustable external fixation ring!
“Okay, Professor Fang.” Gong Jiahe nodded.

The Ilizarov external fixation ring is a fundamental skill for trauma surgeons; without it, osteotomy and reconstructive surgery is practically impossible. Professor Miyaka's skills in this area are certainly up to par.

……

Fang Ziye repeated his old tricks and performed a similar bone graft and bone transport procedure on the middle section of the tibia.

However, after Fang Ziye finished manipulating the fractured ends during this bone lengthening surgery, everyone discovered something incredible.

The patient's shortening was corrected by about four centimeters, and both the appearance of the skin and the tension of the muscles were restored to the normal level of stress.

It seemed neither a fraction more nor a fraction less.

At the start of surgery, due to the lack of stress on the affected limb, the muscles are in a state of disuse atrophy. Atrophied muscles not only become smaller in size, but also become softer and more limp.

Seeing this, Professor Fang Zhikuan couldn't help but recall the third plan that Fang Ziye had mentioned: "We need to specifically design the length of the first surgery based on the patient's muscle condition and skin laxity."

"Skin atrophy lags behind tissue atrophy, which is why wrinkles are formed. This is why many patients who have successfully lost weight still have folds of flesh on their abdomen."

"This patient also has loose skin, so we'll try to make the lengthening as precise as possible the first time, but that requires collecting more data..."

At the time, everyone thought that Fang Ziye's idea was only theoretical and therefore rejected it.

Unexpectedly, Fang Ziye did what the team hadn't done. He really spent a lot of time and brainpower meticulously working on the surgery, in addition to discussing the procedures.

"Professor Fang, did you roughly calculate the relationship between this patient's lower limb length and skin laxity without our knowledge?"

"How did you do that?" Professor Fang Zhikuan asked, adhering to the principle of asking questions when he didn't understand.

"This is actually a clever trick. It's just a calculation based on the ratio of the length of the patient's healthy lower limb to the approximate surface area of ​​his lower limb."

"Disuse atrophy of the affected limb is generally uniform, either proportional to the length, or proportional to the square of the length, or proportional to special treatment. Later, through statistics, a coefficient k was found!"

"However, the sample size is not very large, so it currently has no broad reference value!"

"Of course, the result I calculated is not much different from the result we speculated based on experience. The difference between 4.3 centimeters and 3.8 centimeters is not enough to cause the skin to tear."

“After our bone grafting surgery, the external fixation frame helps to stabilize the bone, so the bone transport wouldn’t fail. That’s why I took the liberty of making the decision.”

"So far, the results are pretty good, just right."

"When we discussed it before, the main difficulty we focused on was controlling the distance. Based on our experience, the error was about 1cm, and mine is within the 1cm tolerance range," Fang Ziye explained.

After saying that, Fang Ziye carefully examined the surgical field again, and after finding no problems, he breathed a sigh of relief.

Actually, nerves and blood vessels atrophy the slowest. Their current length should be about the same as before the patient was injured. There is still some redundancy, but it has not been detected.

This is a very mature surgical procedure.

After the outer fixing ring of Ilizarov was fixed in place and the device for connecting and fixing it was installed.

Fang Ziye then said, "Next, we can adjust it slowly, at a slower pace, increasing it by 0.5mm per day."

"Once the postoperative recovery period is stable, increasing the speed to around 1mm should be fine!"

"Send one sheet!" Fang Ziye instructed the circulating nurse.

The circulating nurses here are all men, so pushing the C-arm machine in the operating room is a piece of cake for them.

After everyone left the operating room, they stepped on the remote control foot pedal for filming.

Immediately, the C-arm monitor displayed various images after the surgery.

At first glance, it can be seen that the fracture surface and the bone graft surface are well aligned, and there is no displacement of the bone graft segment.

The centering of the external fixation ring is also very precise, and the cortical bone between the proximal and distal segments of the fracture is as straight as a line.

This was a high-quality surgery.

Fang Ziye laughed and said, "Professor Gong's external fixation rings were installed very well!"

"Hi!~" Now that they were no longer in the operating room, Gong Jiahe cheered up a little: "Professor Fang, are you scolding me or praising me?"

"Even if I used a hundred external fixation rings, it wouldn't be as precise as the millimeter-scale bone grafting you performed!"

"The total length of 4.2 centimeters was cut in two separate sections!"

"I was also misled by your nonsense. If I hadn't seen what you were doing, Professor Fang, I would have stopped you as the team leader."

The circulating nurse went into the operating room to prepare the location for taking the lateral X-ray.

The C-arm crane's rotation can be remotely controlled for slow movement, but it also needs to be remotely stopped.

Professor Fang Zhikuan also said, "However, based on the current results, Professor Fang's suggestion of two-segment external fixation is still relatively reasonable."

"Looking at the X-ray, the patient's skin folds have disappeared considerably."

"It's possible that I only noticed after Professor Fang finished the procedure that the skin folds on my calves were longer than those on my thighs."

"Therefore, the length ratios of the two bone flaps that Professor Fang took are completely different."

"Is it because there is more soft tissue in the thigh area, so the skin is more elastic? Professor Fang?" Fang Zhikuan had not done any basic research in this area, but he seemed to have seen it before.

Fang Ziye nodded and said, "Yes, that's why the skin on the buttocks and abdomen has the strongest elasticity and extensibility."

"I think this surgery went quite well!" Fang Ziye brought the topic back to the surgery itself.

"Absolutely great, absolutely great!" Yan Huanan finally found his place and simply shouted "666" and that was it.

Although all the procedures in this surgery were within their understanding, and they were even capable of performing them.

But to perform a routine surgery in such a stunning way truly demonstrates a person's skill.

The stronger the team's fundamental skills, the greater their tolerance for mistakes can be!
Top professors, in the end, are really competing on the quality and depth of their fundamental skills.

After taking a lateral X-ray, Fang Ziye and the others saw that there were no problems, so they came out of the lead plate isolation room and went straight off the stage.

The final surgical procedure, including the suturing, was completed by Gu Yi and Qu Shuyuan!

After Fang Ziye and others completed the crucial operations, they could naturally step down.

Sanatoriums don't accommodate idlers. If you can't do this or that, what are you doing here?

Are you just collecting a salary?

At first, Fang Ziye was not used to this model, but now he has gradually become more at ease with it.

You should definitely be polite when you first arrive; people develop feelings for each other after spending time together.

When you arrived, you acted all high and mighty and just stepped off the stage and left. No wonder no one paid you any attention. But after you demonstrated your abilities, Miao Haoyu and the others accepted this rule without needing any explanation from you.

This is what it means to proceed step by step.

After leaving the operating room, it was past lunchtime.

The procedure sounds simple, but even Fang Ziye spent nearly four hours performing it meticulously.

It was past 1 p.m., and although the cafeteria still had food, it wasn't fresh anymore.

There are no other surgeries scheduled for the trauma group; the next scheduled surgery is on Wednesday. There is also no emergency room at the nursing home.

Professor Fang Zhikuan then suggested, "Professor Fang, today's surgery was very well done. Shall we go out and celebrate?"

"Drink a little."

Fang Zhikuan didn't talk much, but he was good at drinking.

Fang Ziye didn't drink before his birthday last time, so he agreed to drink again next time. After thinking it over for a moment, he replied, "Okay, let's invite Professor Miao and the others to join us later?"

"I sent a message to my senior brother."

"Then I'll make a call to reserve a location," Yan Huanan said enthusiastically again.

He holds a rather special position within the group.

He can't compare to the Gong family in terms of reputation, nor to Fang Zhikuan in terms of ability. Now that Fang Ziye has joined the fray, he's even less capable.

But he's a little bit better than the two associate chief physicians!

With average abilities, he's easily overlooked in the group. However, Yan Huanan has very high emotional intelligence. But in the sanatorium, emotional intelligence alone is useless.

Fang Ziye and the others did not refuse.

It doesn't matter who pays the bill. The cost of living in Enshi is not high. A meal for seven or eight people will cost at most six hundred yuan, while their daily wages are all over four figures.

……

Since they had planned to drink, the group didn't drive. Instead, they rode their electric scooters back to the villa to rest for a while before having the sanatorium's shuttle bus take them there.

Fang Ziye noticed that Professor Fang Zhikuan, Professor Yan Huanan, and others each carried some fine wines, such as Maotai, Wuliangye, and Luzhou Laojiao, all well-known brands that Fang Ziye was familiar with.

In contrast, Fang Ziye had no preparations and was wondering when he should stock up on some supplies.

Soon, Gu Yi and the others also came out of the surgical office area one after another. The group went directly to a farmhouse they often visited nearby and sat down in a private room.

As Professor Yan Huanan accepted the bottle Gu Yi had prepared and began to pour the wine, he started talking: "Professor Fang, actually, the key to developing new techniques is innovation; it's about being ahead of the curve."

"On the contrary, it is truly rare to find someone who can reach the level of Professor Fang in terms of basic skills."

"I really don't know how many days and nights you stayed up to achieve your current level of skill, Professor Fang."

Gu Yi said, "I don't know much about the others, but I heard from my junior colleagues in the department that Ziye had to buy cheaper pork to practice his basic skills!"

"It must be frozen pork. Ziye is really putting in a lot of effort in the training room."

"But ultimately, it's all about having good aptitude."

"Even if Ziye tries his best, can he train for as long as I can?" Gu Yi said with a forced smile.

Gu Yi is a few years older than Fang Ziye, which means he has been eating for a few more years. Even if Fang Ziye eats more at every meal, he probably still wouldn't be able to keep up.

The practice time is the same.

"You can't be envious of someone who's blessed with good looks."

"Professor Fang is so accomplished at such a young age, it's something we can only envy."

"Professor Fang, are you really planning to go out and perform that flying knife consultation this time?" Professor Fang Zhikuan asked.

"Actually, Professor Fang, we don't need to go out and do a good job with the surgeries in our own sanatorium!"

"We'll see how things go. I haven't made a decision yet, but I'm really interested in this patient."

"I might go, or I might not. The patient's main problem is that the aneurysm is difficult to treat. Otherwise, I might have transferred him to another hospital," Fang Ziye said.

Upon hearing this, Gong Jiahe looked at Gu Yi and said, "Gu Yi, look at your junior brother, what kind of talk is that? He's interested in this kind of disease?"

"What, do you find this kind of disease, where you don't know if you can get off the stage after you've been on it, exciting?" Gong Jiahe's double chin was pulled into a slit, as if he was mocking Fang Ziye.

Actually, it's also for Fang Ziye's good.

Listen to advice and eat well. For Fang Ziye, there is really no need to take the risk of getting sick, since everyone else is avoiding it.

However, Fang Ziye had his own plans. If it was just for the sake of surgery, he certainly wouldn't take the risk!
However, this patient's aneurysm is highly relevant to his research on interventional treatment of bone tumors.

This was an agreement between him and Nie Mingxian, and Fang Ziye couldn't do something like digging a pit and then leaving it unburied.

Fang Ziye smiled and was about to reply when the phone rang.

Upon picking it up, I saw it was Professor Qu Tangwei from the Department of Internal Medicine.

Fang Ziye had previously promised to help his relative with a functional reconstruction surgery, so it was scheduled for tomorrow.

I guess they called again to remind me.

Fang Ziye's eyes darted around for a moment before he answered the call: "Professor Qu."

"Hey, I definitely remember, we didn't have any surgeries scheduled for tomorrow, we deliberately left it free!"

"You've submitted the report, right? Okay, I also told Dean Chen that I've already reviewed the case file. Don't worry..." Fang Ziye replied, feeling that he was becoming more and more old-fashioned.

The expressions on everyone's faces when they looked at him were varied.

(End of this chapter)