16th SNI & SNI Digital Baghdad JIA Lecture and Discussion copy
Welcome to the sixteenth SNI and SNI Digital Baghdad Neurosurgery Online meeting on August Seventh, two thousand, twenty two,
the meeting, originator and coordinator, Samer Hoz, MD, Universities of Baghdad in Cincinnati.
The lecture is on the future of neurosurgery and medicine, presented by James I, Ausman, M.D.,PHD., Dr. Ausman is CEO of Surgical Neurology International, and SNI Digital, Dr. Ausman as the former professor of the University Of Minnesota, Michigan, Illinois, and UCLA. and is the former head of neurosurgery at Henry Ford Hospital and the University of Illinois at Chicago.
The lecture is 40 minutes, Intergenerational global discussion session is 15 minutes, and the discussants are from Iraq, Usa, Iran, Sweden, and there are one hundred and twenty two attendees. From eighteen countries around the world,
Video editors are Mustafa Ismail, M, D College of Medicine, University of Baghdad, and Fatima Ayad, fourth year medical student University of Baghdad, I'm going to try to tell you from my perspective What I think it's going to be in 2035, and what it's going to be and 2100, with some specific examples. There's no way I could do a thorough analysis and fifteen minutes. This is the the first slide. If a patient comes to 60 years old male, with a sudden hemiparesis arm, and leg
That's what he has. He's got a hemiparesis At that time. The CT scan you do, shows these two little encircled dark spots in the brain. They are called Lacuna infarcts. Forty years ago, nobody knew what to do with him. Nobody knew much about them and little angiography was being done.
We had CT scans as you could see at this time, and then there were some MR. What do you do?
There was a professor at the time, who was a neurologist, He was at Mass General Hospital, His name was C. Miller Fisher. He was the first to study and write about lacunar infarcts. His is one of the finest papers I've read in medicine, Archives of neurology, 1979, C Miller Fisher Capsular, Infarcts.
He had these 10 patients like this with 11 infarcts. He asked a question. He said. What's wrong? What do they have? He autopsied the patients, and then sectioned the brain from the lesion to its vascular source. He made 1000 to 4000 sections per patient. Yes that is right, 1000 to 4000 sections per patient . An incredible amount of work, but what he wanted to do is to trace the source of that infarction. This is what he found shown on the slide. You see the mark MCA for the Middle Cerebral Artery, and off that is a lenticulostriate branch. It's called one of the lenticular strange arteries. You see the branches filled with some some blood, but most of it is filled with an atheroma made up of inflammatory cells, macrophages, that are filled with fat. There are other blood vessels around also. You see the dark blood vessels what are almost blocked. In the right panel. he shows a blockages occurred in the lenticular stride arteries within millimeters of the origin from the middle cerebral artery. In this slide here's the midline of the brain , And if you look at all these different vessels he shows lesions in in all of these cases all near the origins of the vessel.
Here's another case. This vessel here is filled with macrophages, Atheroma is filled with fatty lipids.. This is reported a 1979; that's forty years ago, The lenticulostriate arteries are irrigating the basal ganglia which you see here in the picture on the right hand side,
These small vessel occlusions are the cause of 20% of strokes? Yet nobody knows how to treat the disease. . Nobody knows how to make diagnosis. This is now forty years later.
This is something anybody in Baghdad can do. Dr. Miller Fisher did a wonderful study, outstanding study. He had patience. He had an idea. He went ahead and reveal this information. You can do this in Baghdad or anywhere in the world.
We did some experiments in the laboratory looking at the lentil striate arteries. You're looking at a surgeon's view, looking down with the frontal lobe elevated, You see the distal part of the middle cerebral artery in yellow and also the proximal part in blue. You see the Anterior Cerebral Artery in red. See the optic nerve, So what we did as we isolated the anterior cerebral artery or the proximal Middle cerebral artery and the distal middle cerebral artery and injected them with yellow dye for the distal middle cerebral artery and blue dye for the proximal MCA. We injected red dye for anterior cerebral artery, because we wanted to see what the distribution of those blood vessels was to see if we could understand this disease,
This is another specimen. You see the distal yellow vessels of the MCA . There are many of them. There's only two coming off the proximal MCA segment in blue, and there's only two coming off the the anterior cerebral. These are the major vessels supplying the basal ganglia.
So what is the blood supply? When we section the brain we found in this is a section. You see the the lateral ventricles. Here, see the the frontal lobes here, and they occipital lobes are back in the down in the bottom. This is the basal ganglia which you see globus pallidus and the putamen and you can see that the red from the ACA vessels fills both sides. Not completely. You see a little yellow stain on the left side and there's your stain in a spot of blue on the left side, which is in the internal capsule. So what kind of symptoms did the patient present with; this patient would present with an isolated pure hemiparesis, . Perhaps some sensory symptoms we don't know from the yellow where it's going to be, But you see in the same patient. The distribution is different on each side of the brain. Each side of the brain is supplied by different lentil striate branches. It is not the sam on both sides of the brain. , and then will we do to section a whole series of different brains. You could do this. You can do this in Baghdad. You will find if you look at each brain, you see that the distribution of the colors is different on one side of the brain than the other and the rest as you can see it well, but it's still yellow on the this next picture on the bottom. You see it's below. And it's a mixture of yellow blue and red up here in the top, its mixture of yellow blue and red. What it means is that the vascular supply to the brain to the basal ganglia is different between in in one patient, and among patients, so these patients come and they present with an embolus to the middle cerebral artery. They are going to have present with different clinical syndromes.
Here is another way you can find that out about the blood vessels to the brain using MR angiography. Here is an example using a new kind of technique that is only available in a few hospitals in the United States. It's not available around the world. It's a 7Teslamagnet MR with which you're able to see tiny blood vessels. These are small micron size vessels. . These are micron, four to eight hundred micron blood vessels.
In the nineteen eighties we developed CT scans and then MR scan were developed in the 1990s. You see the hinger definition in t 7 Tesla scans compared with the 1.5 and 3 Tesla scans. It shows you the increasing detail that you're seeing and now here's one under 7 Tesla , There's very few 7 Tesla scans around the world , which shows the incredible detail that you're see. What's the message from what you see? . If you don't see it. It doesn't mean it's not there. It just means we don't have the technology that allows you to see it.
That's why I asked about the the Gamma Knife. The tumors that we were treating before we had an MR scans, and CT scans. Angiograms did not help us. We used pneumoencepalograms. We injected air around the brain, and if we found that the brainstem was enlarged we would assume that the brainstem had a tumor
and many of those people were treated with radiation. There was no diagnosis made because it was too dangerous
It turned out many didn't have a tumor but received the treatment anyway, so you have to know what you're treating before you're treat it.
So you do the very best you can, and this is what's happening.
This is what's coming in the future. better imaging to see more detail. This is going to change the way neuroscience and medicine is practiced because we are going to see things we have never seen before and it'll change your life and it'll change patients' lives. Here's another one. The 1.5 Tesla scan showing virtually very few blood vessels. Then we get a 3 Tesla. You can see the blood vessels. Now look at 7 Tesla- filled with blood vessels.
Can we use the seven Tesla scan to tell us what's going on in the lenticulostriate arteries in those 20% of the patients who are about to have a stroke because of the fact that one of those vessels is included like Dr. Fisher showed? Are we going to be able to show this ahead of time and treat it well? Can Interventional radiology show this?
Regular angiography can only show you a vessel about a millimeter and and higher maybe sometimes five hundred microns or eight hundred microns. It can't show you the blood vessels that are very small micron diameter. Those are the size of the lenticulostiate vessels. They are 50 micron vessels.
I went to the Buffalo, and they had enough an angiographer who was able to guide a small catheter up the lenticularstriate vessels so you could do an angiogram. We did the an angiogram , blocking off the middle cerebral artery and slowly injecting angio dye to see those vessels so you can make the diagnosis.
Once you made the diagnosis, then the question is what are you going to do? How can we save these twenty percent of the people with this disease. Nothing can be done today. so everyone gives up on this 20% of patients. But wait, here is an example of something that was done.
This is a case example of a forty five year old man is from Japan in 2015. He presented with a visual field deficit, from an occipital lobe infract on is CT. Apparently they found no cause. They treated him with aspirin which was common at that time.
He came back six months later with dizziness and a loss of consciousness. He had an angiogram, which showed bilateral vertebral artery occlusions. That means that of the 4 blood vessels supplying the brain this many only had two working. And those were the two supplying blood to the back of his brain and posterior circulation. If you look at each carotid artery, no posterior communicating arteries can be seen or no connections to the posterior circulation of the brain are visible on the angiogram. The posterior circulation of the brain supplies the brainstem and occipital lobes or vision center. There's nothing you can do to treat this man.
The Japanese, did a 7 Tesla MR angiogram on this and to understand his problem better. They find this very unusual twisted vessel coming off the carotid artery going back to the posterior circulation. Actually that same type of artery comes off the other carotid and goes back to fill the posterior circulation Now the basilar artery is filled and we see both posterior cerebral arteries which fill the occipital lobes. . We didn't know that without an MR angiogram; the regular angiogram didn't tell us. So, what do you do now? Give up? You can't give up.
This is you? This is your family. You cannot give up.
You have to find the answer and there are people all over the world in rich countries who give up. You can't give up just because you have money and you're in a big country and you are in a developed country. That does not mean they all have the smartest people in the world in that country. There are smart people are in this meeting. In Baghdad, in Iran, in China, there and everywhere in the world in South America,
and don't let the people in the developed world make you think what you have is not good. Because what you have is outstanding. You have talent. You can buy talent. You make talent, create talent. This man had this deficit. It explains why he had a loss of consciousness. It explains why he had an occipital lobe infarct. He didn't have enough blood going to the brain. This is a blood flow test. If you see red and yellow it means a lot of blood is going there. If he it shows blue and green. There's not enough circulation to those areas. After being challenged. His blood flow went down in the occipital lobes and like his brain stem. That's why he lost consciousness.
So there was a treatment for this man with this blood vessel disease.He had a cerebral bypass to improve the blood flow to the posterior circulation.
So here we are back to how do we solve this problem of small vessel diseases. Those small vessels we saw on the MR angiogram are like the lenticulostriate ateries in size. Twenty percent of people who have strokes. Nobody knows yet what to do. I just showed you an answer from some smart people in Japan who asked the right questions.
But this is something you can work on in your future in medicine.
This can be solved. And it turns out that the disease causing all of these deaths is atherosclerosis. I'm going to come to that. Look at this. When you get an MR scan, you also see the white matter of the brain that you can see here. We didn't see this forty years ago. We didn't see it twenty years ago or seeing, and now ten years ago, but fiber tract imaging tells you what is going on in the brain and how complicated it is, and what is it that we don't see. Because there are magnets out there that are 23 Tesla but they are not used clinically.
What don't we know?
So don't be like everyone else and believe nothing can be done. . It's true in our country, don't be so confident that you know all the answers cause you don't. Just because you don't see anything doesn't mean it doesn't exist.
What about atherosclerosis? This disease is common everywhere in the world. It's been treated for the last seventy or eighty years.
Still nobody until recently knows what this disease is,. This is what it is. It's an inflammatory disease and here's an example of what happens in atherosclerosis. What happens is a break in the endothelium of the blood vessel. Then a macrophage goes inside the blood vessel wall , you can see down here where the macrophages are capturing all these lipid particles which are in the blood and is becoming foam cells, so it's filling the blood vessels underneath the endothelium with these yellow cells that are filled with fat. The plaque that is formed gets bigger and bigger. Eventually it breaks through the vessel endothelium. And when it breaks through a blood clot forms to the blood vessel surface at that point.
Up to now we were treating these people were Stanton. drugs. They do not treat this disease. Everywhere in the world people are bering treated with these drugs which do not work. There is not a treatment for this disease. What about using antibiotics to treat this disease. People tried that and failed. I'll show you something. Maybe we have to find a treatment stopping the macrophages from forming a plaque and also by diminishing the patient's blood fat level.
Maybe that's the treatment for these diseases. Maybe that's the treatment for the lacunar infarctions, Dr. Miller Fisher talked about.
Now what about cerebral aneurysms? What do we know about them? We don't even know how they form!,
and we do not know why they grow. We don't know when they're going to rupture. We don't know how to treat vasospasm. In Japan. They're concerned about aneurysms. Two to five percent of the population has aneurysms. Ten percent of the stroke deaths are from aneurysms Fifty percent mortality.
That's not very good, and that's not very good everywhere in the world. Because everybody's got that statistic not just in Japan. They are worried because there is a large number of people with unruptured aneurysms in Japan, and they're going to be at risk for this disease. What do you do about it? They found if you look at some of the pathology studies of aneurysms, there are some inflammatory cells around the aneurysm. This paper came out of Japan. Japanese are outstanding in vascular neurosurgery Better the Americans.
They found that aneurysms were a macrophage mediated inflammatory disease. I'll show you a diagram. There's a blood vessel at the bottom. Here's a blood vessel carrying blood through into the brain. As it gets through, There's a green colored macrophage, and once it gets through into the muscle layer of the blood vessel, there's a whole bunch of inflammatory cytokines in all kinds of small molecules and signaling molecules that are released that says to the macrophages grow bigger and bigger, and when it grows bigger, What happens is it destroys smooth muscle in the aneurysm in the wall of the vessel and an aneurism develops at that spot and it keeps getting bigger.How can you stop it? While there some drugs out there that will stop it in a shown this diagram. There are some genetic factors telling the macrophages to growing and keep growing, There are some factors stopping the aneurysm from growing. So how do you treat this disease? Now we have an idea of what's happening. Here is an image showing the smooth muscle in the vessel in purple. This is a stain which shows muscle in the in the blood vessels, and you can see here there's very little muscle where there's very little muscle as an aneurysm.
Now Japanese doctors were able to go back and use a drug that essentially stop this whole aneurysm from developing. It blocked the macrophages from growing in the blood vessel wall which then can heal. They had another control group where they gave no treatment to stop the macrophages from growing , and that group turned out to have aneurysms, The other group you can see There is no aneurysms, There is smooth muscle all the way around the walls which has bee been repaired in the treated animals.
Does that mean the treatment for aneurysms by the 2100 is going to be treating a macrophage induced inflammation of the brain that can be stopped by drug treatment?
Is that the future. Yes, it is. But the Japanese doctors wanted to go further. They wanted to know what aneurysms would rupture so they can prevent the disease..So they went and did some more experiments. They went to the laboratory. They injected some iron particles into the blood vessel, and if there are no macrophages involved with the aneurysms , the iron will not get Into the macrophages in the blood vessel and will not show up. But if they've injected iron particles in the blood the iron particles are taken up by the macrophages and the macrophages are in the aneurysm, then these macrophages with iron in them will show up in the aneurysm, and and we can see that on the brain images. .
So what did they do? This is an image of an aneurysm in the blood vessel before being given the iron particles. And this next image os after the particles were injected and then filled the aneurysm wall macrophages, and the last image is after subtracting the first image from the second, all we will see is what is left and that will be the iron particles.
In this last Subtraction image the red arrows show the aneurysm wall with the iron macrophages . Are these dark spots?
And if you look where the yellow is? There are no iron spots there which means there are no macrophages there and the vessel wall is intact. Which means there is muscle there.
So they found a way to diagnosis disease using an MR scan before it grows and kills fifty percent of the people.
Now The problem with this is that the iron used for the diagnosis is too toxic and causes an allergic reaction, so they're working on it getting a better imaging agent.
This is this is outstanding work so that all comes from working and looking into the biochemistry and molecular biology of what's happening with the disease. There are some people young people in this call who are not going to be a neurosurgeon.. They are going to become neurologists. Are they are going to go into medicine.
These are things you can do no matter what field you going into to solve diseases. Eventually, you're going to have to have a team of people who are involved in doing this, not just a surgeon.
And what you're going to find in the 21 st century is that inflammation is a major disease of the twenty first century. If you go back in history ten thousand years ago to Mesopotamia, which proceeded Iraq, the major diseases were infection. Then people died by the age of thirty, Then doctors began to cure infection. That it took awhile. It took to the 1850s or 1900s and we were able to cure some infectious disease and people were living longer, so then they got atherosclerosis and cancer and other diseases.
You think that's going to be true One hundred years from now, that we will not know how to cure these diseases? I I don't think so,
and here's an article published via a good friend of mine who is a neurosurgeon who's very interested in molecular medicine and has studied the subject in great detail. He wrote about it before many other people. Went through the same experience, Everybody said No you can't do this. You're crazy. He said Parkison's disease is caused by an inflammation in the brain. He said this ten years ago,
and now people are beginning to understand. It's chronic inflammation. Repeated repeated insults to the brain by toxins or by infections. The toxins stimulate the micro glia which are the defense cells in the brain to grow. These cells become macrophages. I just talked to you about macrophages in aneurysms and atherosclerosis, and I showed you that from Dr. Fisher. These cells are now hyper sensitized, and if more insults come to the brain, then what happens the growing macrophages discharge messenger molecules that attack the nerve cells and open their membranes and let toxins in then nerve cells which then die. This he called immune excitotoxicity. The cause of Parkinsons leads to a chronic inflammatory disease.
You are not going to find much written about this , but more more is coming out about why people believe that this is a cause of Parkinson's disease, and Alzheimer's. I had a good friend is a neurologist who loved to develop his own pictures in his own laboratory. He inhaled the toxins from those chemical which gave him toxic neuropathy and he died of that disease Nobody knew what he had. I've told you about atherosclerosis. Same thing. No one knows the cause until now. Everybody is suffering from Covid around the world. Now we're talking about long Covid. . What is it? It is repeated insults to the brain by not only the virus from now buy the vaccine , and a vaccines containing the spike protein, stimulate the immune system, to hyper react. . That was one of the causes of early deaths in Covid . It was excessive release of toxins in an allergic reaction, but nobody wanted to talk about it.
Arthritis is common disease around the world. Almost 50% - 100% the people in the world will get it in their lifetimes. Nobody knows how to treat it. The surgeons to go cut it out. There's some studies out there that show that if you stop cartilage loss, you will stop arthritis. Because the bones will rub together. There's also studies out there that show that if there are stem cells in the endplates of the bone that can be stimulated to regrow. Why don't we see that reported in the literature? It doesn't make money.
Rheumatoid arthritis is a disease that can been cured. I had the disease. I was treated with a molecular agent called Enterocept. It was autoimmune diseases stopped bypassed the Anti tumor necrosis protein in the Eenterocept. So chronic inflammation is going to be the major disease in your lifetime. This can be found everywhere, but nobody's paying attention to it.
What about precision medicine ? It's called molecular medicine or genetic medicine?
What's happening? In people with sickle cell anemia or some blood disorder. they can give agent to the patient and can cut that abnormal gene out and cure the disease genetically. They take the patient cells out. They get the stem cells from bone marrow. They cut out the abnormal gene. Then using radiation they destroy blood cells in the body. And then they put these stem cells back into the patient. They've produce normal blood cells. The disease is cured. It is called CRISPER technology. Cavernous malformations, have now been found to be caused by a series of molecular events, and it's related to the same
signaling chain that causes a meningioma by a neurosurgeon from
France. A neurosurgeon has done it. Outstanding work. . He is way ahead of everybody else.
Here's the paper on mutations in spontaneous cavernous malformations. Eighty percent of malformations cavernous. They can rupture. They can hemorrhage. We can treat that. But it is some drugs that will stop this cascade, a genetic molecular cascade.
So what will neurosurgery be like in the twenty first century, and in look like?
First of all, the diseases at the end of the twenty first century, all these diseases are going to be gone
For most of you, If you have the right diet, you live appropriately, you
are going to live to over 100 years old. Your average age in in Iraq, now is over seventy.
Vascular disease. I just showed you. It's going to be cured as with neoplasia or tumors. They are also going to be cure degenerative diseases. I just showed you inflammatory degenerative diseases of the brain. They're going to be cured. Spine. We've got to get the spine surgeons to think differently. That's going to be hard.
Right now. You have to do that, but we have to work in some of the basic reasons that causes a major disease involving all people in the world. Trauma will be with us. It must be with us forever,
There are people are making progress. They're finding ways to limit the amount of damage in the brain are finding ways to regenerate nerves. There is a presentation we had a year ago on repairing the spinal cord, cutting it in half. Totally reconstructing the spinal cord. Dr. Hadi presented this three weeks ago one spinal cord regeneration.
Stereotactic and functional. We've seen talks last week about incredible talks. I think it's a wrong name for their disease. It should be neuro cellular and tract disorder not stereotactic and functional. That's a frontier and neurosurgery. It's going to be explosive is going to tell you about psychiatric diseases. All the kinds of diseases I just presented here today, Many of them that you can't treat. 2 billion people in the world with depression or on antidepressant drugs. Infections, we've already started in the , Nineteen thirties, with antibiotic treatment.
Pediatrics, we talked this morning about a folic acid supplements which can stop central nervous system disorders. The article in the New England Journal of medicine, Is this article right here came out yesterday, and what they're doing is they found that if you can operate on the fetus. In the womb with myelmeninigocoele and close it you reduce the complications of that disease before birth, and after birth by fifty percent.
Fifty percent. What about the fifty percent of people are dying from aneurysms. Can we fix it? Yes, we can.
I'm sorry to tell you. I think skull base surgery is going to disappear.
It's a means to a decision, a path to treatment not a treatment. .
I think we're going to have to look at medicine differently
My father grew up. He was a private practitioner. Dr. Hadi was in private practice with many of the other people here. That's what they're doing now, But things are getting complicated. We're going to need to have lots of people involved treating a problem. I just showed you that today these are complicated problems. When you have teams of people, researchers, neurologists, medicine people, all kinds of different specialists working in teams,
diagnosis of medical disease that can be made by computers. IBM made a computer where it was able to diagnose medical diseases
but it was not accurate enough.
There will be telemedicine. People are now using telemedicine. You can now reach all parts of Iraq by telemedicine. Treating people will
be done using remote surgery, because in the rest of your life, people are going to be going to space. Having space diseases in space medicine. You're going to have to operate on people in space.
So that's if you can't see it. If you can't see anything, It doesn't mean it doesn't exist, and this is a picture just taken three weeks ago from the newest telescope. The Webb telescope, looking out into space and and the picture shows you in a very narrow view space, thousands of galaxies, just like ours. Thousands!
What does that mean for the future, hundreds of thousands of galaxies surrounding us!
So much the future, Now, fifty percent of your population in Iraq is under twenty years of age, and seventy five percent is under the age of fifty. That means you're young.
That means by 2100 the population of Iraq is going to be 100 million people from forty million today. Today, that means you need a lot of doctors. That means you will need a lot of people working to be able to take care of your people. .
We have one principle and I found use it my whole life, the one principle that Surgical Neurology International follows. There are no characteristics by which we judge a paper, except scientific fact.
I don't know who sends the paper in I do not know If it is a male or a female. I do not know what country it comes from. It doesn't matter to me.
And that deals with all the talk about bias. I hear about everywhere. It doesn't matter particularly to a doctor, and the reason is because you're treating a patient, and it doesn't matter what religion a patient is, what skin color they have. The patient is. It doesn't make any difference in what you do. It does not matter what they believe. It does not matter what they practice. Your obligation is to treat that patient. The very best you can, and fifty per cent mortality isn't good enough.
So, thank you very much. Write me at jamesausman@mac.com. that I hope that this talk has been helpful to you. That's one person's view of the future. Thank you.
Thank you so much part of this mind blowing
toke than in. Guess what's going to happen in the future. It's amazing, really, and they're comparing it to the Webb Telescope Is is very appropriate to think. What can we don't see it. It's not necessarily as stop there. I remember the gym. A paper written by Richard Win and Matthew heard in the Lancet in December, nineteen, ninety nine about neurosurg detail in the coming hundred years.
Of course, it's not as elaborate as what you presented to really have some new things which I. I'm sure they didn't know anything about that at that time.
Today and they they, they, they went through, or the the The The the the steps, which is going to happen to neurosurgery, they said, the first half of the century, you will have been the mechanical insurgent, mechanical neurosurgeon, and that robotic and other things, mechanical things, and then the second half will be as exactly what what to upset the biological surgeon. The Bs, and neurosurgeons would be redundant. They don't have much to do, and the day he said that to thought, they said that when you have some problems with mathematics, you can go to the neurosurgeon and you put the chip of mathematics on your head and then you go back home and then they will have your good in mathematics, and also they can take at night. You're muddy. They record it, and then when you have stroke or head injury, and then they can put that money back to you. When you were a cupboard. It's amazing. It's just. I think that's just. Cod, but what you are telling us, you're telling us facts and amazing facts, and we are really so much thankful for for your effort to get all these things together and to tell us about that, so thank you so much again and your tank and care, Dr. Ausman. I will wait a fair. That is a comment from analysts. Also, at. Actually, it's estimate eighteen dog, and it's an eye opener when
they have a common differ, Id, and I think Oussama has a question or Zama. Yeah, so
I love Dr. Osman. Thank you very much for the fantastic talking. Thank you to the organizing committee
for making this conference and Doctor has for inviting us. I have a bit of a personal question to daughter Respond. If that's all rights, My question is. What got you to where you are with this level of knowledge and and the comprehensive knowledge about like everything, even outside like medicine?
The question was how Arab Arab, could you say that one hundred I get that knowledge Are what got you to where you are or what got me to Was
how do you can answer the answer their question, and so so so good, I I e Yasser
Abdul, or anyone, It's it's
What was you want? A cheaper? Do better. The most important thing is to be the very best you can,
and excellence is the goal
you're growing up in a world
where mediocrity is a goal as where everybody's gotta be equal.
That's not going to lead to excellence.
I learned long time ago that there are people all over the world who are very smart, smarter than I am,
and those are the people who you're competing with those are the people in the United States. That they don't understand. They're not competing with the best people in the United States. Their competition is the best people everywhere in the world. Some of those people are in Iraq. In. I miss call today outstanding people done outstanding, thanks,
so I think the answer to that no matter what field you choose is to be the very best you can to work very hard and to achieve excellence and that's what you should do.
Thank you, very much, softer, Rossman and Kill Osama For the question am I wonder if Dr. Audi, or upset, I didn't have a comment also?
That was the he guess and one thing I had,
and it's very hard to find many open minded academic cn to walk and talk, and Dr. Ausman is one of the exceptions. I have to tell you I have work around the world with many people. I was lucky to work with very great mentors, But one thing his various vision with the crosswinds video open to anybody, because many unfortunate given us prejudice, and makes nice. I have gone through a lot myself. Not to buy. My have great people to work Be bought. Bridget didn't exist, but I have to work hard as he mentioned, and that's from city. Kids don't give up. If they don't like you. They don't like your region All your national. I have gone through one of those, but. Yeah, good to be like the Ausman who suffered. I love you young people nor dust, just do your best as he image.
Thank you, Dr. Ali, Thank you. Yeah, you're a writer. I think we should just take a minute or two to a doctor. Hurry and and and Yeah, sure and edit it and
then
and and she initiates. A were to answer entire dose. Share your favorite answer the question or Sharma. Ashish. How do you get to be where you are and also my good for him to haughty, Because the young people should not just here for me. I should hear from them as to what and how do you get to be successful
or you want to start an answer their question.
Yeah, you're muted. Yes, Yes, thank you, sir, Thank you, Well, we face these problems. My my personal experience, we face the difficulties during the
the sanctions on Iraq and my mentor, my teacher knows at that time what difficulties we face Even though we are,
we try our best
we enter, We need to struggling to get information from here and there,
Because so we thought that that time we should, the near the surgery has the best we can.
Even we faced difficulties of that time because of the assumption because of the war, because of the. Condition or the circumstances at the time era faced, but I still, we are, he believed that Nero neurosurgery as our way, and you should be succeeding in this way,
I believe in.
Yes,
you do what you are up. Is I am here, and also the the seasonal bogus itself. After one hundred years, we're facing a new disease are now, where are our thoughts or thinking and the Brisson diseases which weakens
success in treating, like all the oncology. We don't know what the exact mythology. If we treated by the sways. What's what are mentioned in the future. The disease is also intelligent, and twelve develops a sales. Not only be viruses, bacteria, bacteriology, Richter about bacteria, also other disease,
and it is.
The one time of treatment, medical surgical biological, and might be another technological advance, technological progress in treatment, It is a button and thank you,
Yeah, Well, My, my Yeah life trip as a full of
for the difficulties, and I really overcome these difficulties, and put that in my memoir, I that I, the age of eleven, I decided to be a doctor, and I worked hard for that, but then I failed in the third tier to the intermediate, so I had to go to the commercial side rather than science, and the then I went back to science. I last one year of my life, but I didn't mind that because my goal is to be a doctor and then and there her highschool.
I did not score the enough a total of my marks to get to the medical school, so I went to the engineering, and then for for the first week, they opened the gate for other people to come to the medical school at night, when there, and then in the first year, I failed in biology,
but then night pasta okay when I came to the clinical. That's my passion, and then I progressed until I was the top graduate and the medical school. When I finished and nineteen sixty six, So the hurdles in my life that I locked. You can't possibly see them in the memorial to determination to overcome them To reach your goal is the most important thing in life, so you may be pushed sideways sometimes to away from your path, but you have to struggle to come back to your took path and fulfill your your aim in life.
One one think the thrall spend your saying goodbye. Yeah, you don't mind. You don't care about who said something, but you care about what you said. We have in fact, saying in our culture, exactly the same.
Let go. A lemon pie were like an umbrella. My God. Don't care about who said, but cared about what was said,
Understanding Center Center Center to America. They need to hear that,
or do you have a question or a? Yeah, Yes,
it's what's about stem cells. So what about stem cell. The cell stem cell progress on neurosurgery.
I'm not. I'm not really very knowledgeable about that. I don't think I can answer, But you're right. Some of the things I read had to do with stem shell, said they were able to reactivate. Ah. I'm I'm Just after confession, I'm not knowledgeable about it. Yes is while some some progress, but even though it is not so much in neuro urology pumps, and let's be knew that renewed was finally caught repaired, but not the very very exactly a promising result was Yes, correct
cardiology shows another person has your question.
Yeah, cardone of years of you may not know me. I'm a another neurosurgeon happily. I'm a orthopedic walk -in in Sweden, with fine. Thank you for a presentation to Osman. I ask you or add to your view that. Maybe in the next fifty or hundred year, we need to do again, all the researchers who has been has been publicly now. Cause I am questioning the result and the outcome of most other research that has been already publish gated. I. I believe we need to do it again again and again, Because
this is the first thing. Second thing I learned in this country coming from the era of core from pneumonia, If you, too, If you want to be a good surgeon, a good doctor, a good engineer, you have to question the opinion of your mentor. Don't believe in your monitor. Hundred percent tried to question. Because as you said, you have to struggle to the best by doing that, you have to question what is your mentor same and tried to discuss with him or hair about other opinion, Thank you,
thank you very much, very very thoughtful. Well, said, Yeah, exactly
where I can't. We hope you enjoyed this presentation?
Please fill out your evaluation of this video.
Supported by the James I and Caroline are Ausman Educational Foundation, owner of SNI and SNI Digital, and the Wayaster Corp, Producers of The Leading Gen, The Silent Majority Speaks, Role Models and the Medical News Network,
Thank you.
