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SI Digital Innovations in Learning is pleased to present
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The Jorge Lazarus Lecture Series on the origin and development of ideas in the clinical neurosciences. This course series consists of seven one-hour lectures with discussion
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The speaker will be Jorge Lazarev, Emeritus Professor of Neurosurgery, Department of Neurosurgery, Ronald Reagan, UCLA Medical Center, Los Angeles, California, USA Thank
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you.
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This is Dr. Lazarus introductory comments to his lecture series, and we quote, The most significant number of patients with diseases of the central nervous system live in low and middle income
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countries for no other reason than the majority of people are living in low and middle income countries.
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Let's start over.
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This is Dr. Lazarus' introductory comments to his lecture series, and we quote,
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The most significant number of patients with diseases of the central nervous system live in low and middle-income countries for no other reason than the majority of people are living in low and
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middle-income countries Nonetheless, neurosurgeons and neurologists from high-income countries offer most research papers on clinical neurosciences.
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This disparity is prejudicial to the neurosciences as a whole.
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We designed the course as an introduction to some of the tools that promote the genesis and development of research ideas
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This series of lectures are provided for you to bring the advances in clinical and basic neuroscience to physicians and patients everywhere.
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One out of every five people in the world suffer from a neurologically related disease
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Lecture five, epistemological analysis of two cases of disappearing low grade gliomas.
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So, I'll do a quick introduction for those who like maybe attend for the first time. Yes, so this is the first hello everyone, I'm someone where money is six grade medical students. This is the
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fifth lecture in the neuroscience course in the development and origin of ideas presented by Dr. George Lazarov, and I'm going to be recorded and published in the SNI Digital so that you can access
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it after the end of the course. Here we go, we can start. Nice
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to see you again. Thank you, Sam. So, good evening to all of you, to the 27 of you, as Sam and I am using your name, your first name is expressed many of those, I mean, all these lectures
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will be uploaded. They are recorded as we as I speak now. And they will be uploaded in surgical neurology digital. It's a free site. You just have to register and don't even think that register.
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You just go there and can listen to these lectures. Besides, we are preparing a text based on all those things The lectures I thought that will be uploaded once every week. But as I just want to
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see to compare and some of them, I may do some of the changes just for clarity and based on the questions that you were asking. Last Friday, I promised that I will avoid completely the theoretical
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structure But as you probably saw in your PDF, I couldn't avoid that complete theoretical structure. structure, because everything is a theoretical structure, no? It's like knowing anatomy,
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knowing physiology. You cannot talk about clinical medicine with anatomy and physiology. So last week, nor asked if which were the main problems or the fallacies regarding our approach on our
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analysis of the patient or of the situation. So the origin of the idea, as we discussed before, is the event. You see a patient or a group of patients or you see a radiological study or you see a
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pathology sample that catches your attention, no? A disease or even a social situation. The tools for reasoning when facing any situation are, as we discussed before, the
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dachshund or the dachshund. both of representation in our brains. I didn't put the image again, but you have seen that reference in previous papers. The induction has fallacies. Fallacies that we
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always commit and the same, the deduction has fallacies, two important fallacies that I will refer today with clinical examples. So
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the fallacies of the inductions and I have seen them, those are the ones I more or less recognize.
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The induction fallacies are around like 40 something or 50 something, no? It's a limited number of fallacies that are very well known. The ones that I think they were more common at least in my
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clinical practice as a neurosurgeon And I have been doing that in four. in many countries in four different continents, no Asia, Africa, Europe, and the Americas. One is lack of clarity, the
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use of ambiguous terms, all patients with the GBM die. As you saw in the case of the AIDS, not all patients die. Confusing necessary with sufficient. Presence of a mass is necessary for tumor
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related epilepsy, but it's not sufficient. The core bacilae is necessary for tuberculosis, but it's
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not sufficient. If you are well nourished and well-fed and all those things, you may have the core bacilae, but you may not get tuberculosis.
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Access of proof is not proof of absence. That you don't have a proof that you can see something doesn't mean that something is not there That's the case of a rare patient. No, the patient, we
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don't know what it is. So we actually qualify this as the patient in certain group of things that we know.
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Going back to the AIDS case, the absence of proof that there was a virus doesn't mean that it wasn't a virus.
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Confusing a stage of the disease with a hole, some patient is in bad shape and then you think that's the overall situation False dilemma happened last week. Last week meaning last week. I was
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taught about the patient who had, when she was watching TV, she was watching a movie on TV, she thought she was part of the characters of the TV and she was talking to her children to do things
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related to the action No, there was a. a phone ringing on the TV, on the movie they were watching, and she said to one of her children, go and answer and tell them I am busy. And for a woman,
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she was considered either delusional, crazy or joking, oh, you are making a joke, oh, you're funny. She was sent to the psychiatrist because she persisted with her until finally somebody did an
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MRI and she had a temporal tumor. A false dilemma is what I'm saying that perfectionism is a thing that I will address with two examples, clinical examples. If everything is not perfect and the
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data doesn't fit very well and if everything is not, I should call it, no, then we don't do anything. And aluminum can go in both ways You can say, that's at the medical student who's.
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suggesting this diagnosis is a medical student. It's a woman medical student, oh, my God, that is an adominate. And that thing with a woman happens to happen even here in the United States, no?
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I mean, an appeal to common knowledge, appeal to common knowledge sometimes can be
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offensive because you say any idiot knows about this. And those things are fallacies considered are not just opinions of Lassaré or jogging around are considered to be fallacies of the way that we
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think about when we approach a clinical problem. So those fallacies, particularly the adominate, we are very prone to the adominate The professor said that, Oh, must be true. or the Americans
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are saying something, okay, must be true. What do we know here in Iraq? The false dilemma and the lack of clarity that what helps the logical thinking to improve the clarity.
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And the modus ponens has
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a perfect way of thinking deductively is if A, then B happens to be A, therefore it's B, sounds stupid. But anyway, A, if my reasoning is correct and I perform a decompressive crannied to me,
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therefore the intracranial pressure will decrease. You have a patient who has a stroke or a patient who has a severe trauma, the brain is swelling So you say, okay, what will do you decompressive
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crannied to me in order to expand? the intracellular space and allow the volume to go and the pressure will decrease.
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I decompress, you do the the compression and yes, the hypothesis was correct. The interconnect pressure is lower.
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Yeah, careful with the fallacy. The fallacy is, and I, and you have this on the DPDF to look over and over forever. If A, then B, B, therefore A. Going to the example, if my reasoning is
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correct and I perform a decompressing tranetomy, the intracranial pressure will decrease. B, the intracranial pressure decrease. This is because I decompress and does it the mistake that we all
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are, why we still don't understand how to control intracranial pressure in trauma cases. You see there the difference. If you are femme the A, which is a simple way, I did, if I do the
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compression, the pressure will decrease, I did the decompression, the pressure decrease.
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If I do the compression, the pressure will decrease. The pressure decrease is because I did the decompression. No, wrong.
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And that we always
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find that Next week we'll talk really about Keari, and I have done hundreds of cases of Keari, around 200, not 1, 000. Always with the idea that the decompression and the temperature is, I was
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committing this fallacy over and over again, of thinking, of affirming the consequent, not the antecedent
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And the modus tolerance is the other pair, the modus tolerances, There. The correct way is denying that the consequent, which is the null hypothesis. If my reason is incorrect, and I perform the
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compression, traniotomethintrachranar pressure will
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decrease. The intercomer pressure did not decrease. Thus, my theory is incorrect. That is what is called
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the null hypothesis. It's
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expressed as they are now like that, sounds like a false grade or second grade exercise. Exercise, but keep in mind, watch the daily practice of in cleaning when you are, and you will see that
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people tends to fall into those fallacies when dealing with patients, which is bad enough. And also when writing papers, we want to work on the developing of the ideas. We want you to be able to
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write papers a consistent high. that are going to be consistently published and transformed many of you into clinical neuroscientists or into researchers in this field.
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So, now we start talking about some clinical cases. By the way, what you are seeing now is the artificial intelligence Powerpoint has a program of artificial intelligence, so I write on the
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slide. Now we start talking about some clinical cases and boom. Powerpoint puts this image of people talking around a thing, a mystery. It's not that I choose that
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thing Clinical cases, this clinical case on the left side,
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three years old joy
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comes with this image, image provoked because of. progressive decrease in vision, a three year old child. How do you know progressive decrease in vision because the mother says she was coming
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closer and closer to the TV screen to watch the TV program. That's alert of the mother, of thermologies, yeah. Visual equity, MRI, and there you have it. I just only one image, of course,
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right? And there you have it You see the optic nerve, thickening of the nerve, you see the optic asthma, and you see the temporal pathways of the optic pathways. That's a low-grade astrocytoma or
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a
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pilot-cetic, hypothalamic optic nerve astrocytoma. In this case, we did a biopsy, a needle biopsy, and yeah, confirmed this is a low-grade astrocytoma
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That was in the year 19. 94. We
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had severe fires here in California. The father of this child was one of the firefighters. We go to the bush and control.
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And we just told him, I mean, surgery will be removing both of the nerves and rendering the child blind. Incidentally, I had a similar case around that time. And the family said, yeah, remove
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both of these and we will raise a blind child. I mean, two years, three years. And the young man is about 50 years now and he's blind, but that doesn't have any any any disease. But this but
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this child, we said chemotherapy doesn't work because it's a slowly growing tumor. And as you know, chemotherapy affects fast growing tumor Ravishantarapisa, three year old.
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You cannot do radiation therapy, or you shouldn't do radiation therapy in a developing brain. And the surgery is out of
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question. So that the following system day, just this is what it is, let us be with her. So, but we had a context, we have experience, knowledge, ability to think critically, right? We
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recognized it, some people didn't, no? We recognized it, we said this is a long rate as to say, but we still did the rational analysis, we did the calibration, we did both things, both we were
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doing the narrative and the narrative. This is what we are having. This is what we are dealing. Six or seven months after the official MRI of
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And I had a three year old, yes, she was walking, she was fine, more or less. And we were not asking, putting pressure on the family, how far is she from the TV set? I mean, because we didn't
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want to mention that word at all, no? And six months after, boom. There it is, the control MRI,
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barely a little bit of tumor on the
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right of the nerve in here The chasm is clean, the left of the nerve is fine. And just a tiny bit of thinking there in the optic variations in the temporal lobe. That was all, nothing else.
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And without treatment, fine, fine, et cetera.
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And yes, there are papers that they call this phenomenon with some, the more experienced And also we went to the. to the library, there was no Google at that time. It was 1994, as I said, '94
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to
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'95. And reading context experience, somebody saw this in before, yes. And remember the old subject mechanism of the libraries. And yeah, there is this category called Disappearing Logratas
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Rositoma. Okay, fine, we had this disappearing logratas Rositoma. And I lost track of this patient like 10 years ago, but she was fine. Never the tumor, or the tumor, or monally, she was fine.
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The tumor, I'm gonna wait. Few months after, and what? This is to the compare, no? How about how big was the tumor before and how is the tumor? Six months after, six or seven months after.
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Just to obliterate the name of the patient, I don't put the dates, but yeah few months after and see you later. none, none whatsoever.
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A few months after,
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one of the farm workers in the valley,
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there is a huge collection of farms of strawberries here in California, precisely in this area. And strawberries have to be picked up by hand, you cannot send a machine there with picking up
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strawberries, you will have a strawberry jam. And many of those workers come from Mexico, some of them with papers and permissions, some of them don't, doesn't matter. The
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father of this child says one day
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the foreman asked me to come to come from the field and says, And I knew that something was going to be wrong because the. that the foreman never asked us to come. They always tell us things what
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to do. And as I go to the hospital because your child is in serious problem. And this was three to four year old child, four, long force. And they, what happened to this child? I mean, she was
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stumbling. She was having some issues in walking while walking
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A smart pediatrician has done MRI immediately and the MRI shows this image. This image, yeah, somebody, some of the junior people start doing some deduction, could be, could not be, could be
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some fungi because the child lives in the valley, pesticides. No, this is a tumor. This is a low grade tumor, brainstem, glioma, and that the.
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The pressure on the anterior motor tracks tells you very well the weakness and the pressure in the posterior track in the goal and burvash tells us that she had some ataxia, dysmitria, I mean, the
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whole flooring picture of the astrocyto
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The parents as well, rare thing, because usually parents or physicians they tried to treat treat treat but the parents also decided, no, we want, we just because the conversation was the same We
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cannot do surgery because we'll be devastating the brainstem surgery, we cannot do chemotherapy for age doesn't do anything. Okay, and the father said, fine. We don't do anything. And as you
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know, smart people as you are.
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tumor was gone.
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Because of the nature of the location of the tumor, we have to put the child on the psemitosum and steroids. That's why you see a tiny bit of brain atrophy here.
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And because of the location of the tumor abstracting the for ventricle, we need to put a shunt on it. So the only treatment where the anesthesia for the shunt and the shunt was placed only once, it
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worked all the time. And that's a medicine for a short while when the tumor was very big and she had difficulty swallowing We. never had to do tracheostomy, we never had to intubate there, but
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and this is the MRI of the
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few few months prior and this is the original MRI
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few months prior to this one, to this one. which was around a year, the tumor, as you can see, was much, much, much smaller. This was a treatment on steroids, that's why the atrophy, serial
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atrophy was most marked, but then later steroids stopped. And the tumor continued to grow and the tumor disappeared.
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Based on our past experience. So we said, yeah, okay, we had two cases in a year or two of a disappearing low grade
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In this case, we didn't do the biopsy.
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But the diagnosis was conclusive was absolute. And we ran some blood tests to rule out fungi infection or any form of infection, which was absurd, but we just wanted to be absolutely assured Okay,
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so we go back to the At the theory, and then in theory, as in the puzzle says, abduction is the stage of inquiry in which we try to generate theories, which may then later be assessed as a peer
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says is the he, abduction is the process of forming explanatory hypothesis. It's the only logical operation which introduces a new idea. Okay, the correct start for formulating an explanatory
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hypothesis is more to spawning. If you have to remember one thing of all these seven lectures, five today, two more to go, is this. Remember more respondents is the most valuable tool that stupid
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thing, if A, then B, A, that's for B, so stupid, is your tool, is your tool that opens the door to the research paper And all we have are null hypothesis, not hypothesis, which is modus
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tolerance, right? and always check and counter check for the fallacy in either of them. So we were asking ourselves, what is the factor that calls our attention? We're not going to do a
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case report. I mean, a case report, another, there were already case reports. We were not trying to, people knows already they disappeared, Roma and we may say maybe some confidence. Oh, yes,
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I've seen one, but anybody in the real glioma business in pediatric know that there is such a thing. So what can we tell about two cases? Gender, both were girls, age or both were female, age,
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both were be or five or four A type of tumor was both had no greater serious trauma, but what is that? call our attention is the precise process that I tell you when that is something personal,
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something individual will happen to you, each one of you, no course, no course, no lecture series can tell you what calls your attention, something called your attention. What is that call your
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attention, and what call our attention was the volume of the tumor?
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Wow, this is a big tumor, and I'm showing only on the on the on the on the epitalomically, the chasmatin was in every cat, I don't want to bother you with that. I mean, yeah, it's a bit tumor.
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It's a big tumor. Yes, in female, young below age, you know, for yeah, no way. But this is the tumor. Has anybody looked at the relation between the two more and
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the tumor growth, and by chance, at that time, the paper came in the journal of neurosurgery,
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mentioning for other reasons in tune or something, the gompert's equation. I should have written that the name, but really well. The
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gompert's equation is the equation that tells you that something grows, grows, grows, and then reaches one point and collapses.
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Modernals, or any other, or Coca-Cola, or it is something, they have to balance their growth, because if they grow too much, they will collapse. So, in the economy, they apply the gompert's
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equation, right? If you ask Toyota to open another factory in Congo, they may say no, no, no, no.
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We run. the reason of collapsing the thing. That's the Gompert's equation. Of course, this is the Gompert's equation explained not by an economist, but by a neurosurgeon. So, I mean, but you
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have the idea. So you say, okay, let's look. I've seen if there is retrospectively this relation of tumor volume with tumor disappearance. The big problem that we have in collecting data is the
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same problem that you may have, is that there are very few patients in whom the parent says we don't want treatment, which is something wise. If you say, if
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the parents of a child have leukemia, they say that they don't want treatment for religious reason, it's perfectly acceptable for the daughter to ask for a court order from the judge to force the
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treatment on the child. We have a group of religious believers here who don't believe in the Dominican treatment.
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But with this case, no, there wasn't ground to say that the parents are being bad parents, because as I said, radiation didn't work, you know, didn't work, surgery was out of question. So we,
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then we, as I said, we went to the modus ponens, if I then be B and I, and I will show you how we went. You have it in your PDF, but, so to formulate the hypothesis, we use the modus ponens
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where you're thinking, if A, therefore B, we confirm that A is true, in conclusion B is correct. A and B, and I repeat some of the images from previous lectures, are linked through connecting
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phrases such as, therefore, in consequence, The premises need to be to each other adequate and relevant. No, we are talking about tumor growth and volume. There has to be some relation. We are
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not talking about vitamin C and tumor volume. There is some. And the premises don't need to be one short paragraph. They can have many paragraphs, or they can be the whole textbook of clinical
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neurosurgery That's that the premises, a body of knowledge, A, the letter A in the area, is a body of knowledge. We know that inter-colonial pressure is related to a demon. It's a relative of us
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going to - therefore, B.
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A is the antecedent. It is what we know. B is the consequent. What we know, and I want to see if it's applicable to this particular hymn A is the antecedent, B is the consequence.
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Linking together, we reach a conclusion. We reach a conclusion that A is right or reach a conclusion that A is not right. So how did we formulate, I was working in this paper with a professor of
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radiation oncology and one
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doctor of radiation oncologist fellowship fellow from Poland, so it's been a fellow from Argentina So after our two cases,
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we propose that the following the following.
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We, I put the size, so it's being in my cell, the Rosa, and my bride, after seeing the two, the two cases that I show you that in pediatric logaritha, so it's almost that there should be a
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relation between tumor growth and volume.
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Should be a
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relation, call our attention If we are correct, we will see the data from the retrospective analysis that tumor growth delayed or tumor disappearing after certain volume
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This is our hypothesis, our most points. And yes, we review, I don't remember, say it's in cases, as I said, we don't have that many. And with many
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MRIs, you know, unable to measure the volume of the tumors, we may have had two or three more patients without a good series of radiological evidence. Data shows, I will show you now, that
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indeed there is a relation between volume and tumor growth, and conclusion that tumor growth delayed or tumor disappearing after certain volume. Yeah, there is a relation. You have a volume and
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there is a tendency of the low greatest osteo-cytoma to disappear. And this is the paper, tumor volume and growth, kinetics, in hypothalamic, chasmatic, pyatry, logarithm, lyomas, lacerus,
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vinci, de rosa, and chachroms, the late chachroms.
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It was cited 31 times, not a shaken number, but it was cited. I mean, there are where.
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Because of this paper recently, two weeks ago, I got the
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paper from mathematicians from Saudi Arabia, from the in Faisal University, it asked me some at the comment of something. I mean, you just put the paper there and you never know when it will reach,
35:13
happen to be from Saudi Arabia. And we say, be the athlete law greatly, almost evidence of tendency towards peace and growth, thus complicating the clinical management, our results suggest that
35:29
growth of the athlete law greatly OMA, the salary rates as human beings, largely under the gumpers, the model I was talking, for human growth is useful for understanding the growth kinetics of
35:42
pediatric logarithmic leomas. And this is what we saw, the average of the tumor size of the patient, yeah, there was a decrease, they didn't disappear. But some patients, I mean, an average of
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five, 300 1, years or 40 years
36:01
ago.
36:03
for years and a half,
36:05
the tumor tends to disappear in those patients in whom decisions and parents decided not to treat. So there may be some important relation between those. Okay, that's what we did. Now, our
36:22
conclusion, therefore, we concluded that tumor growth delay or tumor disappearing after a
36:32
certain volume,
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that's all that we conclude. We saw this, we conclude in what we saw.
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We didn't come with any in this particular stage, we didn't come with any hypothetical thing, all the tumors grown, no, no, in the five or seven cases plus the two cases that we had, We observe
36:58
that volume could be a fart.
37:03
And, but careful here with the fallacy of affirming the consequence, remember modus ponens as a correct way of thinking, and as a wrong way of thinking. The wrong way of thinking is will be, yes,
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tumor growth is a guarantee, I mean tumor volume is a guarantee is a certainty that the tumor will actually stop growing didn't say that, we only say if A then B, A therefore B, the wrong way of
37:38
thinking is A, B, B therefore A, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no,
37:48
no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no,
37:53
no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, A, B, B, therefore, A. No, no, no, no, no, no, no, no, no, no, no, no, no, no, no,
37:56
no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no,
37:56
no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no,
37:56
no, no, no, no, no, no, no, no, no, no We hypothesize after seeing the two cases that I show you data from the perspective analysis that tumor growth delayed after sending volume. Therefore,
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if you are correct, we will see data from the perspective analysis show that tumor growth is delayed, tumor disappearing.
38:14
And we put the emphasis on B, we put the emphasis on the consequence and we reach the wrong conclusion. Tumor growth is delayed after reaching certain volume.
38:26
I know that you're smart. The same type of lecture, the same type of presentation to high school students, which are very, very bright, but not as mature as you are,
38:39
will create some metacon fusion. That's why I put this thing on the PDF, ponder about it, use it about it. When you write your paper, put the modus ponens and avoid when you like. in the paper,
38:58
avoid the fallacy.
39:02
So the thinking here will be that - oops, how can I move this in here? The thinking here is that we
39:14
actually said that the - let me move a little bit so I can - seems to be a relation. What we found that it seems to be a relation between volume and tumor growth or tumor survival. It seems to be.
39:31
Following Popper, the analogy is that not also answer why. We are not saying that every tumor long rate astrocytoma
39:42
is going to stop growing when it reaches a certain level. We are saying we have seen that it does happen.
39:53
I think that we are clean with that avoiding falling. in the fallacy or the other one. But then what's the next step? Okay, and now what?
40:05
This observation is not enough for a fellowship in the UK or in the USA. If you
40:11
find these two things in the patients, yeah, okay, we'll not attract attention. Or a professorship at home, or to attract the interests of the audience in a medical conference The audience in a
40:25
medical conference is half of the speakers are the net speakers. The half of the people are there, the speakers will follow in you.
40:34
Of the other half, half are busy with cell phones because they are waiting time. And three or four
40:42
are really interested in what you are gonna say. So, and here it comes again, abduction because what are you gonna say? which I want to say is, that,
40:57
some explanation. How will you explain what you are seeing, propose an explanation?
41:06
So the next step is to forward an explanation. Does it the next step? You observe. We observe two cases, call our attention, the volume. We collected five more cases, seven cases, the volume
41:21
Yeah, okay, fine.
41:24
Tell me more. So far, what we told you is, yeah, it's raining a lot, or hasn't rain for three months or whatever. Yeah, fine. Now, how can you explain? How can you dare
41:42
to explain how can you move forward towards an explanation? And I gathered with mathematician here at UCLA, Dr. Newman, and together we wrote this paper. in 2004 or 2005, 2003. Mathematical
42:03
model for self-limiting brain tumors. And this is one of the cases that we
42:11
consider. You see the progressive decrease of volume of the tumor, not the disappearance, but you compare this with this. Without treatment, you see the rich and certain volume And with
42:29
a proper of new men, we came to this, we made this up that certain brain tumors and we propose the
42:43
start-like and then the line assumption
42:47
in our hypothesis will result. I mean, we propose
42:52
a clinical, theoretical, mathematical. explanation of that. And that was it. So we moved forward with our work and proposed an explanation.
43:09
And that is the mandatory step. This paper was quoted seven times. Nothing. I mean, it's 21 years after publishing, but some of the individuals who quoted the were papers that had 600 or 700
43:28
references. So I said, we didn't shoot the world with that. We published in a prestigious journal in that time harder to publish
43:39
and that was it. And then you just wait and see what happens So the
43:50
the value of the paper you will write.
43:54
about your observation is in its explanation. This is what you want to do. You want to be able to explain what you are seeing. And that is a must.
44:11
When you go to the, there are codes of behavior, right? When you go
44:21
to the most, to the church, or the temple, or whatever, there are codes of behavior, right? A code of behavior of a good paper is the explanation. You have to prove, you have to explain, and
44:35
the explanation is everything. With this, I gave you this example from my own harvest, no? I mean, you have a clinical observation. Don't necessarily stop in the taste report, yeah? Some cases
44:53
are worth it, it's report. But in some other, you say, what happened? How can we explain that? Move forward, no? Let's examine this paper. This paper is, by the way, of a very good journal.
45:06
The Saudi Medical Journal is very good.
45:12
I found just because it's a subject of my interest, and this is at the paper that has been quoted 21 times up to this morning, 21 times So 21 authors refer to this paper. It's epidemiology of
45:27
neuroactive defects in Saudi Arabia.
45:31
And the objective is to evaluate the distribution and pattern of neuroactive defects in Saudi Arabia by creating an hospital based registry. Couldn't be a more boring subject. Who is interested in,
45:47
who can be interested in the, maybe some functionality in Saudi Arabia. But this became a phenomenal paper. This became an outstanding paper. As I discovered it a few days ago, and I will write a
46:05
professor, Assam Al-Shahil, Associate Professor of the Department of Neuroscience, it's Kim Faizal, because this is a great paper. And why is it the great paper? Because yeah, they grow in the
46:19
different figures and figure here, figure there, figure there Which is interesting, per se. But then in one moment, in the discussion, they forward an explanation. This is a copy.
46:34
This is one of the three that I noticed, no? They say, you're following here, no? Over the last 12 years, the prenatal detection rate has not improved. That wasn't their intention of the paper.
46:48
They didn't say, let's see what happened to the, no, no, They were looking at. are the national registry, looking at the national registry, they found, oh, look, this isn't improving 12
47:00
years. OK, what? Which is most likely means that that's their idea due to the fact that not all women undergo a detailed anomaly scan is an interesting way of saying, but rather receive a social
47:15
scan. Wow, that's an interesting division, a normally scan and social scan Looking at the presentation, okay, this child is in breach or this child is in normal or the elbow or whatever, or the
47:28
placenta previa. And that's all. And they say the education of the appropriate health providers in conducting detailed ultrasound examination or asking them may actually change the thing. So you
47:43
see, the guys found a data and this is a professor of clinical neuroscience all from neuroscience. It's not an epidemiologist. He found the data, start looking at the data, and they said, wait a
47:58
minute, stop in here. There's no change in 12 years, 12 years. And we are the same at the beginning of the century. Why is that? I don't know, but boom. They forward and they forward a present
48:13
and explanation I checked the titles of the 21
48:20
papers that
48:24
refer to them, that include this paper in their paper. And many are from Saudi Arabia. Many are about the data,
48:34
the general data. But there are two from authors outside of the region who were interested somehow in this particular explanation. So what you will do now, what you
48:49
will do now. What I advise you to do, if you want to do it, go to
48:56
surgicalneurologyinternationalcom. That's the address, I mean, WUWUWU, right? This is the page that will appear. You take summer horse. We don't have to put professor summer horse or doctor
49:09
summer horse, no, summer horse. And then you have to click in here and then click in there eventually at the site because there are so many authors in there, eventually that the site
49:22
comes with something. And the two first papers that come from some of us, from professor, our professor, he has like 60 something. I mean, he has a great amount of papers but the two most recent
49:36
are those two. I mean, your life is. One is societal challenges facing neurosurgeons in low and middle-income countries, Iraq as an example and some of the authors are here in the audience and The
49:50
other one, a case series of gyrus retroteri venous malformation,
49:56
the second one, of course, is a
50:00
series
50:04
anatomical paper, but the first one is a perfect example that both elevates the paper is the explanation
50:15
I heard
50:17
many, many - and I say many, many, many, many, many, because in my involvement in global health and editor of the journal,
50:29
many colleagues complaining or describing, I wouldn't say complaining. Describing the awful situation in which they have to practice clinical neurosurgery in Africa, Latin America,
50:46
some southern countries of Europe. This is not the first one. But what made this paper published, because the other ones were not published, which made this paper published is the explanation.
51:01
They explain why they think that this thing is happening. I challenge you, go, go to this and read the paper and write me back, tell the explanation is this Those of you who are more challenged
51:21
and know and may have time, read it a second paper. Anybody who has knowledge of anatomy and it's a physiology can read it, yeah, it may. Sometimes branches of art that is going up and there and
51:38
gyros, rectos and some issues of the anatomy that for the students shouldn't be at a problem And they explain where they find these. They don't just say, Oh, we actually found this, I found it.
51:53
No, no. They venture an explanation. They meaning all their authors, always, some are also, and then you see all the authors, correlations to them for that, because they venture an explanation.
52:06
They're forward and explanation. So, and read
52:10
those two articles, looking for the explanation. You can send me your findings at J. Lassar of Methane at UCLA, or I will not be checking I just, I will not be tagging. Oh, this one saying,
52:23
this one didn't saying, but just challenge yourself.
52:28
Read those two papers. At least read one, that the first
52:34
one. And read the paper and see what is the explanation. And then you see that is the value, the tremendous value of the paper That is why that paper up to today has been read. 125 times. If you
52:53
go now, you will see 126, yeah, because I am the one who was rooting. I've been read by 125 times. The other paper, the paper by the on the gyros retros, has been read already 257 times. Of
53:11
course, those papers were published in July and June recently, two or three months ago,
53:18
two months ago. Of course, nobody is still citing them because between the paper being published and appearing in a citation, there is a stretch of a year, a year and a half, you know, means
53:30
somebody reads, does the research, published, said it and goes to the data. But the strength of the paper, you will see what makes it the beauty of the paper is the explanation. So to summarize
53:46
what's the the story. You see her at the phenomenon. You in that
53:54
somebody catches your attention. Why those two kids have a tumor disappearing? You saw the example? Maybe we could have chosen gender, we could have chosen age, we could have chosen type of tumor,
54:10
but we decided to choose volume. And we found that, yes, we did the model's points and we found, yeah, there is a decrease But then we did ourselves and say, okay, let's find an explanation of
54:25
that, no? So now this, for next Friday, 100 we will expand a lot on Kyari and we'll see why today, today, today. Kyari still is a mystery that we don't understand how to treat it
54:46
because it's a case of
54:52
modus ponin fallacy, which is ignored by everybody. This is one of my presentations in the Keari, Keari conference, not the one that I will be talking to you, but you will see in this manner,
55:05
you will close the series of letters through the story of the Keari, how the idea has developed. And now, constantly, the different authors, myself included, I have many papers on Keari,
55:24
we kept on falling in paying attention to the monosporters' fallacy. And with that, thank you. Any questions you can let me know.
55:39
How many words? What is 37? I'm 37. Thank you. Thank you.
55:45
Let me see. Okay.
55:54
As you can see, it's simple. We could have, after you will say, that last time needed seven letters to say the same? Yes, because we keep on saying, the same, the same, the same, the same.
56:09
And this thing, for the brave 50 seats of you who are following this till the end, this is the same as training for a soccer thing You say, I always ask myself, why
56:30
the the around times three runs tipper gold field with the other guys? The gold tipper doesn't need to run. It's the gold tipper is standing there. But there is a running, there is a
56:39
training. And this way of thinking is the training to become a great scientist, believe me This is
56:51
the actual training for that.
56:54
Okay then, so if we are done,
56:58
we're done. Actually I have a question, I think. Yes, please.
57:06
Hello, Professor. Thank you for your presentation. As always, I'm fascinated by the magnificent effort that you put in your lecture. I have one question. How can student effectively practice and
57:25
improve their skill in using both more despondents and more distillents? I mean, like, for example, would that be applicable by reading more articles and case reports through focusing on
57:35
explanation, or do you have additional techniques? And thank you. Yeah, thank you. What I propose here, and I'm sure I'm doing,
57:47
I mean, I'm happy doing this, the thing is this It's fine. Let's practice it together. So find something or invent something or find something partially real and partially invented in your
58:03
practice, in your daily practice as a student or as a resident or as a graduate. And send it to me. And we will be working together in those ways of how to use what we said And God knows, we may
58:18
be
58:23
in with a paper out of that. No, how to use the most important ones in clinical neurosciences. But I say that the best way is to actually this time practice, no? So the best way of practicing,
58:40
you send me and we practice at a together. And this of course goes to all the students, no? Yes, that's amazing. I would highly appreciate it. Thank you, professor. No, no, thank you. And
58:58
you are Nour, Nour, right? Branya, doctor, my name is Juan. Juan, I say, no, no,
59:04
yeah, okay. Hi, doctor, can I ask you a question please? Please. Yeah, I just am gonna introduce myself so fast. I'm Zana Thamud, a six year medicare student in Lebanon. I just wanna mention
59:16
that I have as well completed my biology degree now, and I'm thrilled in all the, to joining the Neuroscience Center at my university. So I just wanna ask, I wonder something, I'm really, have
59:31
you taken, don't know which part of neuroscience or which branch of neuroscience? I want to join experts, neuropsychology, neuro-radiology and so on. So can we have your advice if I contacted you
59:42
by email about a care tip or which branch of neuroscience to go for? If you don't mind professor?
59:51
Gladly will do and I will be honest and naive and at this straightforward
59:57
and even I already for some opinion in my mind, the answer. But don't worry, I will not be politically correct. Oh, follow your dream. Thank you. I will tell you, no? The answer is in you as
1:00:14
people tell you. Thank you very much. What doesn't mean if I am asking you a question is because the answer is not in me. Help me. Yeah, of course. Lovely. We'll do it.
1:00:26
Thank you very much. Thank you.
1:00:49
Yes. Yeah, I think that that was a double voice. Now they are mute. They don't have questions. I would like just to ask you before we end up meeting that And I think it's similar in a way to the
1:01:07
question brought by Rania that still, if I am a medical student. I
1:01:16
need, I think you are giving me a way of thinking to produce a paper, but I need something as well on the other hand is that, okay, which is what's the topic was the suggestion So, do you have
1:01:35
any idea or suggestions about topics for student to start with at least.
1:01:46
the
1:01:49
suggestion service are oriented to the personal interest. Your paper, the one on the social the situation of the neurosurgeons in Iraq, is an interesting challenge in paper, formulates and
1:02:08
hypothesis, doesn't prove anything. And I'm not saying what is your answer, what is the answer so that the students will actually read it and will get some at the profit from it, no? But I think
1:02:18
that at the level of the students are important, very, very
1:02:26
important ways of looking at such as
1:02:30
how many, how far, let me think about, but some socially oriented questions about the brain and the nervous system, no? For example, how long it takes for a heavy pain to
1:02:50
the clinic as opposed to other behavioral things like this person that I mentioned was acting with her children through the screen of the TV show that happened two or three weeks ago here. So by
1:03:04
observing
1:03:08
the behavior of the patient and relating that to the anatomy of the brain and the type of the disease, we can find something interesting. An other thing for which we can really find something
1:03:24
interesting and I know how to attract the interest of the American people for that is, and I will mention that next Friday, is carey disease. Carey disease in the United States, there is a
1:03:39
hospital devoted to carey, there is a carey society, a carey group, a carey, carey, Take care, see you in the next video. but coming from what is called low and middle income countries which
1:03:51
are almost all of the countries, they see one or two Kiasi stages of Kieria year. Why is that? Where are the actual Kieri? So, if we work on that with the students, just the simple question of
1:04:08
the patient, but related to the brain, you know, brain anatomy with patient presentation That could be a fantastic project. Remember, it has to be at a project not that you compete with the UK or
1:04:24
the Americans. They have their own tools is that you create your own project per se. So, I will, if one thing that they can do is I can create one or two cases, or three of the most clinical
1:04:40
cases present to the students as an exercise And those who are interested. Answer me and how we will continue with that. How we will follow with that. So we will create an hypothetical case. Not
1:04:55
ideal, an hypothetical case, two or three cases, will give it to you next week or 10 days after. And those students who are interested, we will continue talking and talking and developing the
1:05:10
modus ponens, the modus tolerance of these clinical cases Beluga, thank you there. Thank you. Thank you all of you. Thank you. Thank you for your time sir. Thank you for everybody. Thank you.
1:05:22
Oh, thank you,
1:05:26
Dr. Sanderkal.
1:05:31
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