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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 number seven, analysis of the effects of the environment, a relevant issue for clinical neurosciences, research in low and middle-income countries.
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Good evening everyone, welcome to the seventh and the last lecture on the origin and development of ideas in the clinical neuroscience, which is by Dr. George Lazaref. And for those who missed
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some of the lectures, then I'm happy to tell you that all the lectures are recorded and then be published SNI the in digital at the end of the course show we said now. Yes, we start. So, so, uh,
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good evening to all of you. And, uh, I know that you are 40 something. We are 40 something. I don't know exactly, but then today is the, is the last day. And that doesn't mean that the issue
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is completely closed. But when I was, and you didn't receive a PDF of this particular lecture yet, you will receive it at the end, because until two or three hours ago, a one hour ago, I wasn't,
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I was changing the content of this at the presentation. I started in one way, continuing the other, try to summarize. But at the time, at the same time, try to give you something new, something
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different.
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As Samma just mentioned,
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All the videos will be uploaded. All are absolutely recorded. It's a matter of perfectionism, after finishing. I really want to cut and edit just the beginnings of the little things. The quality
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of the videos is good because it's recorded in Zoom. I made some mistakes in sound in the beginning because I was standing things that I learned for a future at the presentations. Hopefully, we
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will have a chance to meet each other if we really can make true a plan to go to Bardat next year and expand on the concepts we have here. So with all for the loop, we go to this ledge app. At the
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end, Dr. Ross, Professor Ross wanted you to stay and those who are willing to give comment suggestions
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those will be recorded and of course no consequence to your certificate or to my appreciation to you if you are critical or you are very loudly or whatever this is a this is that the purpose of this
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forum no open forum a change of ideas and believe me you believe you think that you learn something from me but I am learning also from you so I appreciate your collaboration
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we started on the on the in the first lecture we say why we talk about this issue and not about how to clip an aneurysm or how to that know so do a neural exam on a newborn baby and there
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is this concept of epistemology is an important branch through which we come to know about the development of human knowledge means and methods of thinking. And this is in your journal, in Al-Abat
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journal, which is from the University of Badat College of Art, and which is a journal available online. You just put Al-Abat, Al-Abat, and boom. And there you are. And they have at the
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coronation in 2023. So it's not a defined journal. It's a journal that's been there for many years And this is what we are trying to do and to make, which is a theory of knowledge, possibilities,
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and tools, which is a lovely title. I will steal it for next presentation. But I will have, I will give Dr. Professor Abbas the due credit for me borrowing.
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Santiago Ramón y Cajal, which was the first scientist who described the neuron.
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He was a physician and he worked with a microscope with a staining by Golgi and he won the Nobel Prize for that and is considered to be the father of neurosciences. But he said something that I teach
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to the students here and I now adding for you that to extend our understanding of the neural function, it is essential that we first generate a clear and accurate view of the structure, you know,
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so that the basic plan can be grasped in a blink of an eye, that's what I call about conceptual things, you know. Sometimes we lose
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the forest by focusing too much on the leaves, you know, what is that we are doing, what is the purpose of this, how we analyze a phenomenon relevant to the the internet will cease them.
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So, to succeed in researching neuroscience, an absolute mass is a conceptual understanding of the narrow system. You need to understand that the narrow system, then you can, and this is the same
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thing for politics or for psychology or history or anything, right? If a politician wants to understand the Middle East, politics he has to understand conceptually, what is Turkey, Syria, Iran,
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Iraq, Afghanistan, how each one plays with each other have a conceptual understanding. Then there were no more geography or history or details, but a concept. And the same applies to the central
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nervous system. So as we said many, many times, a phenomenon is
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the origin of every one of the concepts in neurosciences.
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calls you your attention, and that leads you to keep on asking questions. So to illustrate this point, let's start, let's follow the evolution of our concepts, a very important process that
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started with an observation. In 1919, at the end of the First World War, the American Army had an expeditionary force, and one unit was stationed in a city called Trier, which by the way is where
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Karl Marx was born, but that was a coincidence. Trier is near the border with France, thus was near the actual action, because that was a war that happened most in the trenches between France and
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Germany Unveiled.
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The commander of the unit of the sanitary unit of that particular branch of the army that was occupied in three years decided to do a study to look at the effect that malnutrition, the war and stress
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had on the body of the children You know, they were shorter or they were thinner or the
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muscle or
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the bone, just an anthropometric study. Let's see how the war affected the body of the children, of the school children.
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And the teachers said, Yes, fine, beautiful. And they brought the kids to the children to the unit to be measured And one of the teachers said to this commander and he says, They are doing very
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poorly at school, too.
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And this man said, oh, that's an interesting. We have a psychiatric here in the unit called Smiley Blanton. We'll ask Blanton to study this issue.
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So Blanton,
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interesting character later in life, I will not expand on him. He really was curious about that. So he started looking and produced this paper which is calledBental and Nervous Changes in the
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Children of the Voltskullen of Thrier caused by malnutrition. He came to the idea, this is caused by malnutrition. Not by the war. Not by being orphans, some of them orphans because the father
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went to war and died. Not by the stress of the father coming by the wounded or the mother dying, no, by malnutrition. And I will not expand on this, but it's an interesting study, some things
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that were not perfect, but with whatever tools he had, he is the first person in 1999 to say, malnutrition affects the brain. And an affected brain by malnutrition affects your intellectual
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performance.
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Now is a concept that you see it Yes, yes, of course, no. Before 1999, it wasn't, of course. How about you thought about that? So through this observation, he came to that and he published
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the paper. I have had a copy, I mean, I did a photocopy, found a journal here in the library at UCLA. And
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that paper was read by a few people, but one.
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two individuals who read that paper where Dr. Stoch and Dr. Smith in South Africa in an hospital where I work in the 80s in the Red Cross War Memorial Children's Hospital.
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And they say if we observed in animals that the production of neurons is decreased with malnutrition And this guy, Blanton said that, and they say more or less like that, and this guy, Blanton
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said that affect children. In South Africa, there was a racially unequal society in that time, you know, they were the Europeans in one side, they call it as they call it them or the Africans on
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the other side. And this portion were the poorer people So they decide to measure the heat. it's in conference of the children, which today is an absolutely stupid idea. Who must if Smith and
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Blanton want to propose this study today, they will be sent back to medical school. But they came with this idea and they found, I will not go into
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the details there, just to show you, yes, they actually found that children who did not perform well at school, children who did not and were malnourished because they came from the poorer part of
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town, of Cape Town, those were, those had slightly smaller head circumference compared to an American standard, a standard from the United States and a standard from other wealthy people in. It's
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fine, that's continuing from smiley The Blanton observation comes. church and Smith the observation. And then comes Dr. Brown, a British daughter in Uganda in that time was not an independent
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grad. And in
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Dr. Brown was a pathologist. And he knew which child was malnourished or not. And because they did autopsy, this is a hundreds of outopsies. So he started waiting the brain of those who were
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malnourished with those children who were malnourished. And children who died for other reasons, not neurological, specifically brain diseases. And they found that yeah, that was those who were
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poorly nourished, the brains of those poorly nourished were less heavy than the brain of those who were. And this is in 1960.
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1966, 1966, so two or three years after Stosch and
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Smitty, and he could, Stosch and Smitty in his references, he says, Stosch and Smitty found this, I wanted to continue and see if this is true or not, and interesting, you see how the idea was
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developing, but those individuals were like you, they were trying to find objective anatomical measurements. Blanton didn't have any anatomical measurements, he had what the teachers told them,
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but then he
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looked, those skis, what they ate every day, and all those things, but these two individuals were developing an anatomical, heads of conference, which was not correct, brain weight, were
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moving through an anatomical evidence and an anatomical explanation.
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20 years before that,
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the Netherlands
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were occupied by the Nazi Germans.
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In 1945,
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the British and the Americans combined, they decided to launch a parachute attack on Holland and in order to secure the bridges that will allow the troops, the American and British troops, to go
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into German. The attack failed, failed completely, boom, it was a failure. And they - but the population, when they saw the American and the British coming, they start coming out of the streets,
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and they start celebrating, and they start waving flags. But then the Germans come back. Nazis came back and they punished that population
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and they punished that at the population by
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cutting the food ration. People had one loaf of bread and one glass of milk for the whole day I mean, it was a disaster. It was really a painful, vengeful, malicious attack on the regular
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population.
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Now, some of
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those people who suffer from this, they were children. Many, of course, you know, young children, one year, two years, three years.
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Some of them, some of the women were pregnant, say it's seven, eight months in the, in the pregnancy,
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or earlier pregnancy. That was in 1945.
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But then the 60s came, somebody from the Netherlands read the papers of Brown and Stoch and Blanton, and I say, Well, that's interesting. We have mandatory military service in that time in the
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Netherlands. Or if it wasn't mandatory, it was close to mandatory military service. Every young adult of 20 years old had to go to the army.
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So there you have a whole population of young men, in this case, who 20 years ago were subjected to extreme measurements of malnutrition. Of course, Not the whole country, not the whole
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population, but those. coming from that region that behaves in such an enthusiastic way that led the Germans to punish them. And sure enough, they actually found, I will not go into the details
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of the famous Dutch famines study that
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shows that, yeah, malnutrition affects your brain.
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Not necessarily that you became mentally impaired, but malnutrition affects your brain. And as you can see, observation from Blanton, curiosity, determination, and the theme starts growing and
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growing and growing. And by 1960, people start thinking of malnutrition affecting your brain
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They're Chileans,
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people from Chile. South America. They start looking at the decision. They described a particular type of
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child, the boss child, the child in the box. This is a picture from Bolivia, but that's the idea.
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I presume that you don't have that in Iraq. We don't see this in the United States. We see the lot in Latin America.
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The mother selling goods on the street to the cars
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and their child, or their children, in some cardumbots, right, put over there to stay while the mother is working, because she cannot tell. But that child is a child in the box. It doesn't have
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sufficient motor stimulus is not doing what other children what you did or you're siblings do now or, you know, children do that, which is running, jumping, touching, being yelled at, but don't
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do this, don't do that, but being children. And that created a particular psychological condition in which the lack of stimulus impaired the developing of the brain.
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I will go to the anatomical evidence of that So,
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slowly we have the two parallels, the two roads, one the road, the observation of a phenomenon, because they were interested. And the anatomical evidence, the anatomical explanation, why are we
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seeing these? They were explaining. And remember, that's my word of the day for you or this legend, explain, explain They
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were explaining and then came. The Landmark study, which was not an anatomical study, but they quote Blanton, they quote Smith and Stoch, as their inspiration. Smith and Stoch, mostly. And
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this is a fantastic study, and anybody interested write me. I send you on the PDF. It's written in scientific Americans, so it's not written with very technical language. So what they did, the
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two researchers, Brown and Paul, they say, OK, let's figure it out if this is real, as people are saying.
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So they went to a village in a couple of villages, in the highlands of Guatemala.
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And they choose the same family.
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But one brother or one sibling had a very good breakfast. Atole, Atole is a supplement, ATOLE, right? at all it, perfect breakfast and the other just had. fresco, fresco with a sugary sushi,
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like coca-cola or like one of those things, right? But savor, like orange, one of those things,
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and the two siblings, so same family, same parents, same house, same environment, same everything.
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But one of them had a good breakfast and the other one had a poor breakfast.
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And they were watching them how they were doing at school.
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Wonderful. In less than a year, they actually found that the difference was so stunning that they stopped their experiment. They said, We just can't continue experimenting with this. The kids of
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the same family, those siblings who received nutritious breakfast
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at a much better outcome and performance at school than those who did not receive either by breakfast. But still, this is an evidence that is sort of, yeah, it's the evidence that school at that.
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Show me the evidence. Show me the anatomical explanation more than the evidence, the explanation. It's playing that to me. Yeah, the school, the highland No, no, no, no. Show me the actual.
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And then came those Benides Bribiesca, another researcher in Mexico. And this research was possible. This is a purely anatomical research. It was possible because in Mexico at that time, in the
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1990s, I was there until 1993,
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Basically anybody who died in the hospital had an auto.
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So, and the director of the hospital where I work is and said, I have to sign work in there. That if something happened to me in the hospital, I have an autopsy was a, like the last service
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provided to the patient and then,
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and because this is the, they work in a, in a hospital of the so-called social security system,
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they knew the economical background of each child, whether they were middle class, they were not from the wealthy, the wealthy families went to Texas. They knew that the background,
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economical background and socio-economic status of each one of the families
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and they did outopsy and they did study other brains of those children.
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Is this figure here? The A is a normal dendrite, no? Remember dendrite, one of the branches of the neurons. No, neurons are one arson and as many dendrites, right?
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They take kids of dendrites, the normal, people like you, us, me and everybody, or most of the people, we know, they had multiple buttons, dendritic buttons. You see those black, black dots
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around the dendrite, and those buttons are places to connect with other neurons.
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So, the image that we have from the textbooks is that one dendrite connects one with one atom from other neuron, no? Well,
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no, the dendrites have multiple buttons, like multiple plaques in your room, and those plaques connect So the more buttons you have, the more connections you can do.
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right? So the more dendrites you have, the more connections you can do. And why is this important? You are able now, perhaps, at this moment, to listen to what I'm saying, maybe checking your
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email, maybe messaging, some answering some of the message, maybe as maybe you know. Or, at the same time, you are able to associate ideas. You are seen a clinical case. You remember another
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case. You remember where you read it. You remember what the professor said about that. And you remember what you thought about that. And all those things are valuable in the
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working of the intelligence. People who, children, who are malnourished,
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were in the bees usually. Yes, they had the analytic buttons, but not as many as those who had. And there was an anatomical, significant difference that I will not go into the details, but what
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was this thing was actually showing. Yes, indeed, what Blanton observed and caught his, his attention, Stortunesmith, Brown, and others in between. And then Brown and Pauli, confirmed
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as an anatomical basis. And that this anatomical basis is what propels that the paper propels the idea or the concept to a different level.
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Think of this,
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when we were born, when we were born, we were children, our head, said confidence was the head said confidence of a baby. Right? But now, our head said confidence is much larger.
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If we don't get more neurons, if we are born with the same, the maximum number of neurons that we are going to have.
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How come our head is larger? Why our brain grows? What is this thing that makes our brain grow? And you see that on the chart on the right side in here,
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there is an increased significant increased number of synapses, of
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connections.
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of density of
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synaptogenesis as density of connectivity, density of connections, that while your head is not a bigger, that was Stoch and Smithy mistake, your head is denser.
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The simple analogy, you can have a room with one plaque and one computer or the same size room with 15 plaques, electric power plaques, and you have three computers, you have an audio, you have a
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TV set, you have a lamp, anyway. You don't have fun, anything. And the same size of the room.
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And that is shown in here,
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that, for example, seen and hearing presentive language. higher cognitive function and the sad news for all of us, as then when we turn 15, 16, the thing stopped.
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That's in part why it's harder to learn an instrument after certain age or a oyster to be fantastically perfect than instrument or a sport or a language after certain age.
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I speak English with an accent, you speak English with an accent, but if any Iraqi child or any Argentinian child would have started speaking English, living in England, for example, or in the
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United States, in England, before the age of nine, then he or she will not have any accent is the same, the senses of the connectivity, you know, so
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Deuterogenesis is more active pozzanatally,
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and this lack of stimulus that the Chilean observed in the children in the box is certainly that is the lack of synaptogenesis. The
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more,
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the freer that you allow a child to be, to touch, to smell, to go, to look at the computer, the iPad, or the TV, or at the soccer game, or even if the child lives in the country away from the
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internet, doesn't matter, all those synaptogenesis,
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the understanding of the animal, the horses, the station, the crops, all those things, all those stimulate the growth of the development of the synapses, but if you are like this, unfortunately,
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the
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doesn't matter how much stimulus you have. You just, you don't have the anatomical impetus or the anatomical frame for developing those at the connections. And that is a tremendous tragedy. And
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yes, look at the city scan over there. It's a malnourous child brain compared to a malnourous child brain What is there is the difference is the wide matter, right? But it's less wide matter.
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That's the vengeful suspense. And what is wide matter? Wide matter is myelin.
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And what is myelin? Myelin is fat, right? You're myelin, you have more myelin. Your brain is denser. Which I'm saying, what I told you before, you see the head circumference in both children.
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but the density is different. Myelin, you remember that those atoms who have thick myelin wrap, they conduct the information faster than the other one. Motor atoms are usually thicker than some
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sensory atoms, no? So,
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hunger damages the brain. And all these evidence built around anatomical evidence,
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it has anatomical explanation. So when the psychologists tell you that there is a working memory and proportion of life in childhood poverty, you can explain it When they do a cross sectional and
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longitudinal plots of brain volume, as a.
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of socioeconomic status, and it's a paper from 2008, you can explain it. You can say the myelin, the synaptogenesis, the density of the connections, the dendritic spines. So when you go, and I
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will encourage you to do it, sometime in life when you talk to a politician or to a public or a policy maker person, you just give them evidence, you know, and nothing beats an anatomical
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explanation. That's the best one of all. So from Blanton's paper in a journal that doesn't exist anymore
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to the most prestigious publication in any science, which is Nature. And Nature in 2015, data series of articles, this is the article summarize it not all.
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It says, poverty shinnings brain from birth.
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And if somebody asked you, what do you mean shinnings brain? You say, no, no, we just saw in this slide that the density and the synaptogenesis and the volume of myelin and the density of the
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dendritic buttons and all those things. So you can explain what poverty shinnings the
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brain is.
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Poverty shins the brain for birth means.
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So,
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as I will say now, if the function of the nervous system is communication and communication a student explaining a concept or telling or an individual telling somebody else was the best way to divert
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water to water the crop.
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is communication,
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if the function of the nervous system is communication, to identify the signals from the environment, analyze them, and respond based on all the anatomical evidence, we can explain that the
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long-term effect of childhood
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malnutrition is attention deficit is so, produce social skills, decrease IQ score, delay cognitive development, impaired intersensory integration, and impaired school performance. The number
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seven is not directly related, delayed puberty, yes, because of other nutrients, of the nutrients to other parts of the body. But you see, all the things that are the long-term effect of
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childhood malnutrition now, today, after this lecture, you are able to go to the chamber of Congress of your turn 3 and explain. This is what is happening. because of the synaptogenesis, because
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of the density of the myelin, because of the density of the battles, or the little battles. But malnutrition, unfortunately, is not the only problem.
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We have in a series of problems, but you as one
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very well studied that affects your country, affects this country, and affects almost every country in the world.
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Which is lead,
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lead
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two origins of contamination. The pipes,
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the water, the waterless, that the pipes are not properly done, up in here in the United States, right? The pipes, water pipes. And the other one is the lead from the gasoline, from the gas,
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from the cars and now many,
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uh,
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The Asalines are unleaded, but that doesn't happen in all the countries.
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I believe, I want to believe that you have the unleaded gasoline, there is unleaded gasoline here. But in countries that I would not mention, just something may have changed and I don't want, but
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I have seen recently in the past five years,
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countries that didn't give unleaded gasoline. And you see in this, in this thing, that the child who leads exposure, affects intelligence and status. I've had intelligence rose down and because
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you don't perform well, you don't have money and your status goes down. Okay, you are a clinical neuroscientist, you are faced with this problem. And the only two things that you have to remember
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is what you learn in those seven days in those seven set of lectures. look for the neuron if the neuron is the
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is the issue in here as we said and the neuron is the core of the system for any form of communication and he's telling you that the child who let exposure pets the communication fits the education
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communication then you go and say okay where is the neuron what happened to the neuron how thus let affect the neuron and sure enough it does affect the neuron in Cincinnati city here in
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the north northeast of the United States in the state of Ohio important city
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in Cincinnati they had a lead poisoning event many years ago 20 or 30 years ago So, and then they years after. people gathered some of those children who suffer the, who were supposed to lead
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contamination, they did some form of
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expansional MRI or HMRIs. And they found that, yeah, there were areas of the brain which are in red there who had lead number of neurons, those neuronal death
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And then also, this is a selective vulnerability of the developing brain to lead. And what the lead impairs
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the synaptic transmission, increases the noise of the transmission of information between one neuron and another. Is something that happens maybe a, Unfortunately to some of you because of the
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internet now in this moment when you come out and that you have to come in and out. So,
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you see, taking together these effects have the effect of diminishing the synaptic signal to noise ratio
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The core of this is when clinical neuroscientists face a problem, they focus in only one thing on the neuron. Then, of course, the glare, the blood flow, but also everything centered on the
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neuron
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And this is a problem, as I said, that affects every country in the world, and affects you. There is a paper in Eastern Mediterranean Health in 2012
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And they say is the prevalence of toxic levels of lead. also and so people living in Superman areas. This is a looking at the Kurdistan region in the population of Duhark, Grovernore.
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So you know that those children who were affected to lead in that in 20 or 30 years from now, they will have less number of neurons. Whether
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that they will affect their overall performance in life, no, maybe not, but they have less number of neurons. They have an impaired synaptic transmission. Yes, and those things affect. Those
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things are related.
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One thing poverty fits an improved developing of the brain, impaired developing of the brain fits poverty and all is a circle that you can understand very well. It's not the only factor, of course.
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Of course, it's not the only factor. For everything, there are two or three explanations. We discussed that in lecture four. There
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are other factors. And those are, but one of those is this. And you, as clinical neuroscientists, as medical students, or as people interested in the brain, can explain this and expand They're
45:35
giving you just the directions of this issue. So neuroscience, I don't know why the S is, but it's a combination of those two paintings. This is a painting by American painting, or British, Lucy,
45:52
Mackenzie. And it gives you the idea that
45:59
the brain is something that you can understand and manage looking at the paper and painting. Oh, you did the image on there.
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The painting on the right is from a Chinese painter, which I bought after it was forbidden in China. His name is Manci Thiao, and in which you have the brain there, the silhouette, the brain of a
46:26
person, but maybe you don't see very well, because the image is slow, but there is an open brain, there is a mass of people storming into the brain, and the mass of people means the environment
46:39
per se, right? My brain, your brain, my children's brain, your children's brain is exposed when they were younger. When we were younger, usually the developing brain, to synapses, to noise in
46:57
the synapses, to decrease number
47:02
of neurons, to impair a connection with the synapses
47:08
And if you think that with the exception, so it's not surprise, with the exception of Sub-Saharan Africa, brain disorders are the leading cause of years, leading with disabilities in all the
47:21
regions of the world. Yeah, in brain disorders, we include
47:28
psychiatric problems, but there is an anatomical cause for those. We haven't found them yet, but there is
47:37
Anatomical at the level of micro-anatomy, but there is.
47:43
We have Parkinson, we have Alzheimer, we have dementia. And for Alzheimer, there are evidence of those plates that are there, but also
47:56
part of years living with disability, is associated to poverty, Impaired learning, impaired IQ.
48:10
We have the idea that
48:15
doing neurosciences or neurosurgery, it is only, it is fantastically well done that you put a microstroke and you die set and you safe and improve the quality of life of a person by perfectly
48:29
clipping the aneurysm, removing
48:33
the AVM or doing the surgical procedure for removing a tumor But the other thing can be also
48:45
far toward you, half a child who was supposed to let your parading last child for a posterior fossa tumor sayel, cerebellar astrocytoma, and the
48:56
child is doing well after doing great. But yeah, but his background condition, the
49:04
background noise, prevent him or her to really Go ahead and do better. You did the tumor, yes, fantastic. You did the tumor, you removed the tumor, great surgery, serine, fetcion, seven days,
49:19
whole, complete reception. Logally, that's no need for radiation, no need for a techema. But with a lecture of today, I'm showing you that that patient doesn't come with a brand new brain, like
49:34
when you pull your phone from the box, he already comes with a story of either monetration or either stress or any other, or all the things that we try to subject today. And that, the crucial
49:53
message of this is also neuroscience, art, social science.
49:60
Neurosciences are social sciences. And I gave you clear examples in this lecture. So when you deal and work with your patients who do have a neurological disease that gives you the impression, oh,
50:22
that's a particular, it's a feathery cataxia. No, this is a vascular hypertension, whatever. No, it's a brain that comes with an anatomical history that affects the
50:42
outcome of the patient that you treated. And if you start thinking, looking, and pondering of those patients from this perspective, you will find a fantastic area of discovery and of researching
51:03
neurosciences
51:06
So your task after today is recognize that a phenomenon is speaking your curiosity. You, maybe you go day by day, us, happened to me, what happened to Professor Hoss, happened to Professor
51:22
Osmond, doesn't matter. You recognize that a phenomenon is speaking your curiosity. Oh, this is interesting. Why this child, after same century as this one, this one advanced in school and this
51:36
one is the Linus,
51:39
or another cause that doesn't have to be malnutrition or poverty, the cause could be the pressure of the during surgery or, I mean, is it important to keep a regular pressure during a surgical
51:57
procedure or how long can you have a carotid clamp? Because it may, while you're doing a bypass, or
52:05
the clamp of the middle center, or how long can you keep a clamp at the end? is the same outcome in everybody. Then you forward an explanation. And the explanation you as students, almost medical
52:20
or recent graduate, can forward an explanation because you base it on the analysis of the literature, you use the modus ponens and modus tolenes that we learn here or whatever tool you want to use
52:33
to understand Davidson. Focus your explanation on anatomy and physiology Do not pay attention to the rest. You see some outcome that is not perfect or is better than other outcome. Just find the
52:48
anatomical explanation for that. There is an anatomical explanation, if not created.
52:54
When thinking about your explanation, remember, in lecture four of the series, proper tells you that not all these ones are white
53:05
Every theory is valid until proof comes. that until something comes that, well, maybe it's valid for this occasion, but it's not valid for other occasion. It's in your lecture number four, in
53:19
your previous or four. And remember, quine, also in lecture four of this series, in which he says, for every given volume of data, there are two reasonable, equally sustainable
53:36
explanations to the problem. Imagine failure, academic failure in a region. Why some schools in some area do not do as well as other schools in other areas? Okay, you may have one, two, three,
53:52
because of the teachers, because of the building, because of the crops or whatever. And because of some anatomical reason, one, that you focus on anatomy doesn't mean that those who focus on the
54:06
sociological factors are wrong you are forming. all together, because a squine says, for everyone, there is one that seems to be opposing, but doesn't have to be opposing, they can be
54:21
interlinked.
54:23
And then the most important thing is submit your explanation for publication. If Blanton would not have decided to write and send to this unknown juvenile, juvenile of Igenio, something like that,
54:38
we must have lost, we would have lost 10 or 15 years on this very important field. So don't be afraid if your explanation is sound, send it for the publication. So having said that, today was the
54:55
shortest lecture and I hope was the most efficient for
55:03
all of you. Okay, well they're thinking about question, I might give a question. or explain each about the explanation in general. I mean, if you can't give us examples of what observations or
55:14
explanation we as a medical student can think about, like just few examples, it would be great. Sure, one,
55:26
as you said, as a filmmaker, we as one because I was a medical student, we always thought in the beginning or to have an explanation of something you need or to formulate a question, you need to
55:38
be in the laboratory, you need to have read 75 boards, and you need to, no, no, no, no, just one thing that I always find fascinating is outcome. No, outcome, what's the outcome?
55:53
In the thing for, for example, this, I mean, you see the patient who has had a surgical procedure and you associate clipping off an aneurysm.
56:08
of a middle-cerebral artery and it is no lateral clipping branches boom. And you have seen two or three of those patients and then they do fine.
56:19
And then one patient doesn't do that fine. You see that patient back in clinic with a speech impairment or and was the same surgeon, the same professor whom you admired and needs to be admired and
56:33
interconnected But that extra patient that has a bad outcome or not a perfect outcome is considered as that five percent or the ten percent. No? Well, okay, then focus on that on that patient.
56:48
Try to find out they look at the MRI without offending anybody, without being like a detective trying to finger point. Just look at the MRI. What is the area? What MRI tells you? Is there more
57:02
ischemia. Look at
57:05
this angio. Maybe it has a difference. and geography distribution than the patients who did well. And then you are perhaps creating a
57:20
simpler one, that angio, I don't know how to read angio as well, either a safe or lose, right? Big ventricles, chanted, small ventricles, home, right? Two or three months after, both went
57:27
home, one is doing poorly, I mean, not as well as the other one.
57:43
Okay, maybe it has to do, how big were the ventricles before? Both had their own safe for those. But maybe that the volume of one was higher, was larger than the other one.
57:56
But then you find out that the volume doesn't have anything to do with that. That is a finding, the volume of the pre-operative volume Thank you for watching! in children, in 40 children operated
58:11
in badad, inside the time, was not a factor in the outcome, the intellectual outcome of the children. That's a finding, no? We don't always have to find the thing. We may observe it's not a
58:29
factor and then you explain. Maybe it's not a factor because the pressure is not a factor and then you just find So to answer your question, check on the outcome without being intrusive, not the
58:42
outcome. How compare outcomes? And then when you find five or six or seven patients, you will see one or two are doing differently.
58:53
And that opens the door. Like a PMG, Mr. PMG that I told in the past conference. Everybody dies of face, everybody dies of face, everybody dies of face. Oh, this one didn't die Wow, what's
59:06
happened to me? What was him and that created the whole thing. So outcome on the unusual.
59:16
And then you start elaborate explanation and then if you find something interesting that I can help just write me and I help you develop an explanation entirely on your or whoever
59:29
made it. No, I am not
59:33
putting my name in that I'm not responsible for your explanations. Your explanations are yours. It's
59:44
amazing actually the relation
59:51
between neurosurgery and neuroscience like sometimes how the background of the patient affects the outcome with the surgery and this is the relation between neurosurgery and neuroscience, amazing.
59:56
Thank you so much, Dr. If any of the students have any question or suggestion, it's open for you guys so you can just raise your hands.
1:00:06
And there's any, Dr. Simon, you can give us work in years and for discussion.
1:00:15
Thank you, Samara.
1:00:18
First, thank you, Dr. Lazar, for the full course, not only this lecture. I think
1:00:25
once
1:00:27
it depends on the people, some will already have some ideas, some will need to review some of the videos. But I think that it's, as Samara described, it's a thoughtful discussion. It will not be
1:00:43
available everywhere with this
1:00:47
simplification in the way and also going deep into the complexity in another way. I like it, and
1:00:56
especially the idea of putting anatomical measurement for things. I think
1:01:07
our initial experience was an idea that we and we're including some good ideas. but no good journal except that. And that one, one of the factors that, okay, we need to prove that through some
1:01:23
measurements. And that's, I think many papers we already did. Then we understand this huge addition that people want to see evidence.
1:01:35
I think one of the ideas that I can suggest to the students is that you should attach to a case or multiple cases, according to your opportunity. But once you attach to a patient, once you remember
1:01:55
a full patient story, I think you can apply all the seven lecture on him. And you will generate a lot of ideas I think one patient with those lectures
1:02:13
Google search, you will find definitely an idea, because once you follow a patient or you have been exposed to a full case, that's the key, why this patient is good, why this patient is poor
1:02:30
outcome, as Professor Lazar would describe. And in addition, what are the limitations? I feel this patient didn't accept the surgery because he has thoughts about this and that, okay? This
1:02:48
limitation of surgery, is it available in literature? No, let's make it a publication, let's think about what's the difference here.
1:02:58
Simple things can, as Dr. Lazar described, but I think many in our countries didn't accept, for example, lumbar puncture, as a simple procedure, They will never accept. And I found also
1:03:15
another group of people from other countries also have the same thing that there is a lot of explanations. So for example, if you are following the patient and he didn't refuse a procedure, and I'm
1:03:30
giving here Lambert-Coucher just an example. So this may be as a point to start. Let's investigate what are the indication? What are the contraindication? How people decide on this? And at the
1:03:45
end, you'll solve a social-basedmedical problem. If you
1:03:53
find something through the process, or at least will report the difference in your current, whatever, institute, city, or your observation. You observe some people have this problem, so now
1:04:09
it's a good start I think.
1:04:21
other than a real case, as Professor Lazar described through the full course, it's more a game rather than a real solution for people. Once it's based on a real case, things will be more effective
1:04:31
and I think more easy for you as
1:04:57
a students. Yeah, thank you, Professor Hose, very, very, very thoughtful to think the explanation has to be also sound in the paper of Professor Hose that I suggested you read in two or three
1:04:58
minutes ago, was Professor Hose another authors, some of them are here, but I don't want to, I mean, the one of the great advantage, of the many great advantages of Professor Hose that he has a
1:05:06
name easy to pronounce And that is helpful for me, so I don't offend people. But they, in this paper of what the difficulties and the level of agrasion on Iraqi neurosurgeons, he says, well,
1:05:23
maybe it's tribal culture. Okay, that's an explanation. It didn't go any further with a sociological study. That's a reasonable explanation.
1:05:47
And then who wants to continue continue? Other thing, you know the word poet, right, a poet, you have a poet, a poet, okay, poet, it comes from the grid word poiesis, which is create.
1:05:50
That's why you have organs that are ematopoietids, organs that create blood. A poet is a creator. And what poets do? I mean, when they they create, they don't come. And I know because my son
1:06:05
and my daughter-in-law, they are boys. And they, they don't come and they sit down and boom. with the inspiration for the poem. No, they, they carry it at an old book. And I see my son, we
1:06:20
are having coffee at this moment, write something that he saw something there, and then continue talking. And then three weeks after or four weeks after or never comes something
1:06:34
out of that. So if you carry an at an old book, or as I told you once with the phone, respectfully not showing any face, just the piece of the organ or the tray, covering the name, take a
1:06:50
picture that calls your your attention. And then two or three months and say, Oh, yeah, I saw three. What was the other one? And that's how you actually who know
1:07:04
So that's the, that's the personal point. And
1:07:08
one thing, trust yourselves, trust yourself, believe me. When I came here to United States and I'm talking too much, I also believe, I thought, and maybe it's the same experience with Professor
1:07:21
Hoss, but as this is recorded, we will not ask him to answer. You always think that people here are geniuses that walk on water and the clouds, and they know everything. And then after a while
1:07:34
you say, you know, they're not that smart, or they are not smarter than I have, you
1:07:41
know When I was practicing neurosurgery, I had many visitors coming usually from China, from Latin America. And I say, just go to the OR, be there. They don't let you scrap if you don't have the
1:07:53
license, whatever, just stand there. And you will see that people hear the big names, they made the same mistakes as your people over there in your country, the big names, you know. They come
1:08:05
with the same time. Yes, of course, some of them are very, very good, but they don't work on water. And so don't be diminished. I know that the guy's been saying, oh no, that guy went to John
1:08:18
Hopkins. Who am I to actually tell him? I don't know. If you see something, that is what it is. I just want to thank Professor Rosarov. I think there are some ideas about how we can continue.
1:08:33
There is a research course for us about case reports. I want to modify this course to be like as an application for this one. And then we can meet with you again to show you what we have and to have
1:08:54
more advices and examples from you. Maybe this is one of the options that we are thinking of now and it will definitely keep you updated. And yeah I'm, really thankful for all the time that you put
1:09:10
all the details.
1:09:12
all the details. As we said before, the modification of lecture to be middle East differently. I really appreciate that. I think this is one of a kind of course and we really appreciate every
1:09:30
minute or second we spent teaching us. Thank you We hope you enjoyed this presentation.
1:09:40
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1:09:56
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1:10:00
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1:10:22
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1:11:11
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