Quyen Nguyen: Color-coded surgery

Prevoditelj: Senzos Osijek Recezent: Katarina Smetko

I want to talk to you

Želim vam pričati

about one of the biggest myths in medicine,

o jednom od najvećih mitova u medicini,

and that is the idea

a to je ideja

that all we need are more medical breakthroughs

da samo trebamo velika medicinska otkrića

and then all of our problems will be solved.

i da će tada svi naši problemi biti riješeni.

Our society loves to romanticize

Naše društvo voli romantizirati

the idea of the single, solo inventor

ideju o jednom izumitelju

who, working late in the lab one night,

koji, radeći jedne noći dokasna u laboratoriju,

makes an earthshaking discovery,

dolazi do revolucionarnog otkrića,

and voila, overnight everything's changed.

i, eto, sve se promijenilo preko noći.

That's a very appealing picture,

To je vrlo privlačna slika,

however, it's just not true.

no, to jednostavno nije tako.

In fact, medicine today is a team sport.

Medicina je danas zapravo timski sport.

And in many ways,

I, na mnogo načina,

it always has been.

oduvijek je i bila.

I'd like to share with you a story

Htjela bih vam ispričati priču

about how I've experienced this very dramatically

o tome kako sam ja to doživjela vrlo dramatično

in my own work.

u svom poslu.

I'm a surgeon,

Ja sam kirurginja,

and we surgeons have always had

a mi kirurzi oduvijek smo

this special relationship with light.

svjetlost doživljavali na poseban način.

When I make an incision inside a patient's body, it's dark.

Kada napravim rez unutar pacijentova tijela, ondje je mračno.

We need to shine light to see what we're doing.

Moramo posvijetliti da bismo vidjeli što radimo.

And this is why, traditionally,

I zato, tradicionalno,

surgeries have always started so early in the morning --

operacije uvijek počinju rano ujutro --

to take advantage of daylight hours.

da bismo iskoristili prednost danjeg svjetla.

And if you look at historical pictures

I ako pogledate povijesne slike

of the early operating rooms,

prvih operacijskih sala,

they have been on top of buildings.

one su bile na vrhovima zgrada.

For example, this is the oldest operating room in the Western world,

Na primjer, ovo je najstarija operacijska sala u zapadnome svijetu,

in London,

u Londonu,

where the operating room

i ona se nalazi

is actually on top of a church

na vrhu crkve

with a skylight coming in.

i danja svijetlost dopire unutra.

And then this is a picture

Zatim, ovo je slika

of one of the most famous hospitals in America.

jedne od najpoznatijih bolnica u Americi.

This is Mass General in Boston.

Ovo je bolnica Mass General u Bostonu.

And do you know where the operating room is?

Znate gdje je operacijska sala?

Here it is

Evo je,

on the top of the building

na vrhu zgrade,

with plenty of windows to let light in.

s mnogo prozora kako bi svjetlost ulazila unutra.

So nowadays in the operating room,

U današnje vrijeme, u operacijskim salama

we no longer need to use sunlight.

više ne moramo koristiti sunčevu svjetlost.

And because we no longer need to use sunlight,

I baš zbog toga,

we have very specialized lights

danas imamo vrlo specijalizirana svjetla

that are made for the operating room.

koja su izrađena baš za operacijske sale.

We have an opportunity

Imamo mogućnosti

to bring in other kinds of lights --

koristiti i druge vrste svjetla --

lights that can allow us to see

poput onih koja nam omogućuju da vidimo

what we currently don't see.

ono što trenutno ne možemo vidjeti.

And this is what I think

I mislim da je upravo u tome

is the magic of fluorescence.

čarolija fluorescencije.

So let me back up a little bit.

Sad bih se samo malo vratila unatrag.

When we are in medical school,

Kad smo na fakultetu,

we learn our anatomy from illustrations such as this

učimo anatomiju sa slika poput ove,

where everything's color-coded.

gdje je sve označeno bojama.

Nerves are yellow, arteries are red,

Živci su žute boje, arterije su crvene,

veins are blue.

vene su plave.

That's so easy anybody could become a surgeon, right?

To je tako lako da bi svatko mogao postati kirurg, zar ne?

However, when we have a real patient on the table,

No, kad imamo pravog pacijenta na stolu,

this is the same neck dissection --

ovo je isti taj rez vrata --

not so easy to tell the difference

i nije tako lako uočiti razlike

between different structures.

između različitih struktura.

We heard over the last couple days

U posljednjih nekoliko dana

what an urgent problem

čuli smo kako je rak još uvijek

cancer still is in our society,

alarmantan problem u našem društvu,

what a pressing need it is

koliko je velika potreba

for us to not have

da izbjegnemo

one person die every minute.

da svake minute netko umre.

Well if cancer can be caught early,

Kad rak mogao biti rano otkriven,

enough such that someone can have their cancer taken out,

dovoljno da ga možemo izvaditi,

excised with surgery,

kirurški odstraniti,

I don't care if it has this gene or that gene,

nije me briga ima li ovaj ili onaj gen,

or if it has this protein or that protein,

ili ovaj ili onaj protein,

it's in the jar.

on je sad u posudi.

It's done, it's out, you're cured of cancer.

Gotovo je, vani je, vi ste izliječeni od raka.

This is how we excise cancers.

Ovako uklanjamo tumore.

We do our best, based upon our training

Radimo najbolje što možemo, na temelju svojeg obrazovanja

and the way the cancer looks and the way it feels

i izgleda tumora, konzistencije

and its relationship to other structures and all of our experience,

i odnosa s drugim strukturama i cijelim našim iskustvom,

we say, you know what, the cancer's gone.

kažemo, znate što, raka više nema.

We've made a good job. We've taken it out.

Napravili smo dobar posao. Izvadili smo ga.

That's what the surgeon is saying in the operating room

To je ono što kirurg kaže u operacijskoj sali

when the patient's on the table.

dok je pacijent na operacijskom stolu.

But then we actually don't know that it's all out.

Ali tada mi još ne znamo da je sve vani.

We actually have to take samples from the surgical bed,

Moramo uzeti intraoperativni uzorak,

what's left behind in the patient,

ono što je ostalo u pacijentu,

and then send those bits to the pathology lab.

i poslati to na patološku analizu.

In the meanwhile, the patient's on the operating room table.

U međuvremenu, pacijent je još na operacijskom stolu.

The nurses, anesthesiologist, the surgeon,

Sestre, anesteziolozi, kirurg,

all the assistants are waiting around.

i svi asistenti samo čekaju.

And we wait.

I čekamo.

The pathologist takes that sample,

Patolog uzme uzorak,

freezes it, cuts it, looks in the microscope one by one

zamrzne ga, izreže i pogleda pod mikroskopom jedan po jedan,

and then calls back into the room.

i onda telefonira u operacijsku salu.

And that may be 20 minutes later per piece.

To može potrajati i po 20 minuta po uzorku.

So if you've sent three specimens,

Stoga, ako ste poslali tri uzorka,

it's an hour later.

javit će vam se sat vremena kasnije.

And very often they say,

Vrlo često patolozi kažu:

"You know what, points A and B are okay,

Znate što, uzorci A i B su uredni,

but point C, you still have some residual cancer there.

ali u uzorku C još imate ostataka raka.

Please go cut that piece out."

Molim vas izrežite taj dio.“

So we go back and we do that again, and again.

I tako to radimo opet, i opet.

And this whole process:

I cijeli taj postupak :

"Okay you're done.

"U redu, gotovo je.

We think the entire tumor is out."

Mislimo da je cijeli tumor izvađen.“

But very often several days later,

Ali vrlo često, nekoliko dana nakon što je

the patient's gone home,

pacijent pušten kući,

we get a phone call:

dobijemo poziv:

"I'm sorry,

"Žao mi je,

once we looked at the final pathology,

u posljednjoj patološkoj analizi,

once we looked at the final specimen,

kad smo pogledali i posljednji uzorak,

we actually found that there's a couple other spots

zapravo smo uočili da postoji još nekoliko mjesta u uzorku

where the margins are positive.

na kojima su rubovi patološki pozitivni.

There's still cancer in your patient."

Vaš pacijent još uvijek ima tumorskog tikva u sebi."

So now you're faced with telling your patient, first of all,

I sad ste suočeni s činjenicom da morate priopćiti pacijentu, prije svega,

that they may need another surgery,

da će možda trebati još jednu operaciju

or that they need additional therapy

ili da treba dodatnu terapiju

such as radiation or chemotherapy.

poput zračenja ili kemoterapije.

So wouldn't it be better

Stoga, ne bi li bilo bolje

if we could really tell,

kad bismo mi,

if the surgeon could really tell,

kad bi kirurg mogao točno reći

whether or not there's still cancer on the surgical field?

ima li ili nema tumorskog tkiva koje treba operirati?

I mean, in many ways, the way that we're doing it,

Po mnogočemu, ovako kako mi to trenutno radimo,

we're still operating in the dark.

još uvijek operiramo u mraku.

So in 2004, during my surgical residency,

2004. godine, tijekom svoje specijalizacije,

I had the great fortune

imala sam veliku sreću

to meet Dr. Roger Tsien,

upoznati dr. Rogera Chena,

who went on to win the Nobel Prize for chemistry

koji je kasnije osvojio Nobelovu nagradu za kemiju

in 2008.

2008. godine.

Roger and his team

Roger i njegov tim

were working on a way to detect cancer,

pokušavali su otkriti način na koji bi detektirali tumor,

and they had a very clever molecule

i smislili su jednu

that they had come up with.

vrlo pametnu molekulu.

The molecule they had developed

Molekula koju su razvili

had three parts.

imala je tri dijela.

The main part of it is the blue part, polycation,

Glavi dio je plavi dio, polikation,

and it's basically very sticky

i doslovno se lijepi

to every tissue in your body.

za svako tkivo u vašem tijelu.

So imagine that you make a solution

I zamislite da napravite otopinu

full of this sticky material

punu ovakvog ljepljivog materijala

and inject it into the veins of someone who has cancer,

i ubrizgate ga u vene nekoga tko ima rak,

everything's going to get lit up.

sve će biti osvijetljeno.

Nothing will be specific.

Ništa neće biti specifično.

There's no specificity there.

Tu nema nikakve preciznosti.

So they added two additional components.

Stoga su dodali dvije dodatne komponente.

The first one is a polyanionic segment,

Prva je polianionski segment,

which basically acts as a non-stick backing

koja se ponaša doslovno poput neljepljive pozadine,

like the back of a sticker.

poput stražnjeg dijela naljepnice.

So when those two are together, the molecule is neutral

Kad se spoje te dvije komponente, molekula je neutralna

and nothing gets stuck down.

i ništa se ne lijepi za tkivo.

And the two pieces are then linked

Ta dva dijela zatim povezuje

by something that can only be cut

nešto što se može izrezati

if you have the right molecular scissors --

samo ako imate odgovarajuće molekularne škare --

for example, the kind of protease enzymes

na primjer, neku vrstu proteaznih enzima

that tumors make.

kakve proizvode tumori.

So here in this situation,

Dakle, ovdje u ovoj situaciji,

if you make a solution full of this three-part molecule

ako napravite otopinu punu ove trodijelne molekule,

along with the dye, which is shown in green,

zajedno s bojom, koja je prikazana zelenom bojom,

and you inject it into the vein

i ubrizgate je u venu

of someone who has cancer,

nekome tko ima rak,

normal tissue can't cut it.

normalno tkivo neće je moći rascjepkati.

The molecule passes through and gets excreted.

Molekula putuje krvlju i na kraju se izluči.

However, in the presence of the tumor,

No, u prisutnosti tumora

now there are molecular scissors

postoje molekularne škare

that can break this molecule apart

koje mogu razbiti molekulu

right there at the cleavable site.

na točno određenom mjestu.

And now, boom,

I sada, bum,

the tumor labels itself

tumor se označi

and it gets fluorescent.

i postaje fluorescentan.

So here's an example of a nerve

Evo primjera živca

that has tumor surrounding it.

kojega okružuje tumor.

Can you tell where the tumor is?

Vidite li gdje je tumor?

I couldn't when I was working on this.

Ja nisam kad sam radila na ovome.

But here it is. It's fluorescent.

Ali evo ga. Fluorescentan je.

Now it's green.

Sada je zelene boje.

See, so every single one in the audience

Vidite, sada svatko od vas u publici

now can tell where the cancer is.

vidi točno gdje je rak.

We can tell in the operating room, in the field,

U operacijskoj sali, na terenu,

at a molecular level,

na molekularnoj razini

where is the cancer and what the surgeon needs to do

vidimo gdje je tumor, i što sve

and how much more work they need to do

i koliko toga mora napraviti kirurg

to cut that out.

kako bi ga izrezao.

And the cool thing about fluorescence

Izvrsna stvar u fluorescenciji

is that it's not only bright,

jest to što uz osvjetljenje

it actually can shine through tissue.

može sjati i kroz tkivo.

The light that the fluorescence emits

Svjetlost koju emitira fluorescencija

can go through tissue.

može prolaziti kroz tkivo.

So even if the tumor is not right on the surface,

Čak i ako tumor nije na površini,

you'll still be able to see it.

vi ćete ga svejedo moći vidjeti.

In this movie, you can see

Na ovom videu možete vidjeti

that the tumor is green.

da je tumor zelene boje.

There's actually normal muscle on top of it. See that?

Ovdje iznad zapravo je normalno mišićno tkivo. Vidite?

And I'm peeling that muscle away.

Ja ga odstranjujem.

But even before I peel that muscle away,

Ali i prije nego što sam odstranila taj mišić,

you saw that there was a tumor underneath.

vidjeli ste da se ispod njega nalazi tumor.

So that's the beauty of having a tumor

I upravo u tome je ljepota obilježavanja

that's labeled with fluorescent molecules.

tumorskog tkiva fluorescentnim molekulama.

That you can, not only see the margins

Tako možete ne samo vidjeti rubove

right there on a molecular level,

na molekularnoj razini,

but you can see it even if it's not right on the top --

nego ga možete vidjeti čak i kad nije na samoj površini --

even if it's beyond your field of view.

čak i ako ga fizički ne vidite.

And this works for metastatic lymph nodes also.

Ovo je korisno i u pronalaženju metastaza u limfnim čvorovima.

Sentinel lymph node dissection

Odstranjenje „sentinel“ limfnog čvora,

has really changed the way that we manage breast cancer, melanoma.

uistinu je promijenilo način na koji liječimo rak dojke, melanom.

Women used to get

Žene se nekada podvrgavalo

really debilitating surgeries

iscrpljujućim operativnim zahvatima

to excise all of the axillary lymph nodes.

kako bi se odstranili svi aksilarni limfni čvorovi.

But when sentinel lymph node

Ali kad se u terapijskom protokolu

came into our treatment protocol,

pojavila metoda odstranjivana „sentinel“ limfnog čvora,

the surgeon basically looks for the single node

omogućila je kirurgu da doslovno traži onaj limfni čvor

that is the first draining lymph node of the cancer.

koji prvi prima tumorsku limfnu drenažu.

And then if that node has cancer,

Ako taj limfni čvor sadrža tumorske stanice,

the woman would go on to get

ženu bi se upućivalo na

the axillary lymph node dissection.

odstranjenje aksilarnih limfnih čvorova.

So what that means

Ono što ovaj postupak predstavlja

is if the lymph node did not have cancer,

jest da ako taj limfni čvor nije sadržavao tumorske stanice,

the woman would be saved

žena bi bila pošteđena

from having unnecessary surgery.

nepotrebnih operacija.

But sentinel lymph node, the way that we do it today,

Ali sa „sentinel“ limfnim čvorom, kako se to danas radi,

is kind of like having a road map

to je kao da imate autokartu,

just to know where to go.

ko vam govori samo kamo trebate ići.

So if you're driving on the freeway

Pa ako vozite autocestom

and you want to know where's the next gas station,

i želite znati gdje je iduća benzinska postaja,

you have a map to tell you that that gas station is down the road.

imate kartu koja će vam reći da je ta benzinska postaja niže.

It doesn't tell you whether or not

Neće vam reći

the gas station has gas.

ima li na toj postaji goriva.

You have to cut it out, bring it back home,

Vi to trebate odstraniti, odnijeti kući,

cut it up, look inside

izrezati, pogledati unutra

and say, "Oh yes, it does have gas."

i reći: "Aha, da, ima goriva.“

So that takes more time.

A to traje dulje.

Patients are still on the operating room table.

Pacijenti su tada još uvijek na operacijskom stolu.

Anesthesiologists, surgeons are waiting around.

Anesteziolozi i kirurzi čekaju.

That takes time.

To traje.

So with our technology, we can tell right away.

S ovom tehnologijom odmah vidimo o čemu se radi.

You see a lot of little, roundish bumps there.

Vidite mnogo malih okruglastih kvržica.

Some of these are swollen lymph nodes

Neke su natečeni limfni čvorovi,

that look a little larger than others.

i izgledaju nešto veće od ostalih.

Who amongst us hasn't had swollen lymph nodes with a cold?

Tko od nas nije imao natečene limfne čvorove kad je bio prehlađen?

That doesn't mean that there's cancer inside.

To ne znači da imate tumor.

Well with our technology,

Ali, s našom tehnologijom,

the surgeon is able to tell immediately

kirurg može odmah odrediti

which nodes have cancer.

koji su limfni čvorovi zahvaćeni tumorom.

I won't go into this very much,

Neću previše ulaziti u to,

but our technology, besides being able

ali ova tehnologija, osim sposobnosti

to tag tumor and metastatic lymph nodes with fluorescence,

obilježavanja tumora i metastaza metodama fluorescencije,

we can also use the same smart three-part molecule

može koristiti te iste pametne trodijelne molekule

to tag gadolinium onto the system

za označavanje gadolinija u sustavu,

so you can do this noninvasively.

i to vam omogućava da odredite tumor neinvazivnim putem.

The patient has cancer,

Kad pacijent ima rak,

you want to know if the lymph nodes have cancer

vi želite znati jesu li limfni čvorovi zahvaćeni

even before you go in.

i prije samog zahvata.

Well you can see this on an MRI.

To možete vidjeti na MRI-u.

So in surgery,

Dakle, u kirurgiji

it's important to know what to cut out.

važno je znati što trebate izrezati.

But equally important

No, jednako je važno

is to preserve things

očuvati strukture

that are important for function.

bitne za normalnu funkciju.

So it's very important to avoid inadvertent injury.

Vrlo je bitno izbjeći nehotične ozljede.

And what I'm talking about

Ono na što mislim

are nerves.

jesu živci.

Nerves, if they are injured,

Živci, ako su oštećeni,

can cause paralysis,

mogu prouzrokovati paralizu

can cause pain.

i bol.

In the setting of prostate cancer,

Ovisno o položaju raka prostate,

up to 60 percent of men

čak do 60% muškaraca

after prostate cancer surgery

nakon operacije raka prostate

may have urinary incontinence

može imati urinalnu inkontinenciju

and erectile disfunction.

i erektilnu disfunkciju.

That's a lot of people to have a lot of problems --

To je mnogo ljudi s mnogo problema --

and this is even in

a to se događa

so-called nerve-sparing surgery,

čak i tijekom operacija očuvanja živaca,

which means that the surgeon is aware of the problem,

kad je kirurg svjestan problema,

and they are trying to avoid the nerves.

i pokušava izbjeći oštećenje živaca.

But you know what, these little nerves are so small,

Ali znate što, ti živci u kontekstu raka prostate

in the context of prostate cancer,

toliko su mali

that they are actually never seen.

da se praktički nikada ne mogu uočiti.

They are traced

Njih se locira

just by their known anatomical path

temeljem znanja o anatomiji živaca

along vasculature.

i njihovom putu uz krvne žile.

And they're known because somebody has decided to study them,

A to je poznato jer ih je netko odlučio proučavati,

which means that we're still learning

što znači da još uvijek učimo

about where they are.

gdje se oni nalaze.

Crazy to think that we're having surgery,

Ludo je pomisliti da operiramo,

we're trying to excise cancer, we don't know where the cancer is.

pokušavamo odstraniti tumor, a ne znamo gdje se on točno nalazi.

We're trying to preserve nerves; we can't see where they are.

Pokušavamo očuvati živce; ne vidimo gdje su oni točno.

So I said, wouldn't it be great

I tako sam ja rekla, ne bi li bilo sjajno

if we could find a way

kad bismo mogli pronaći način

to see nerves with fluorescence?

prikazivanja živaca uz pomoć fluorescencije?

And at first this didn't get a lot of support.

I u početku nisam imala mnogo potpore.

People said, "We've been doing it this way for all these years.

Ljudi su govorili: "Radimo na ovakav način već godinama.

What's the problem?

U čemu je problem?

We haven't had that many complications."

Nismo imali previše komplikacija.“

But I went ahead anyway.

Ali ja sam svejedno nastavila.

And Roger helped me.

A Roger mi je pomogao.

And he brought his whole team with him.

I poveo je sa sobom cijeli svoj tim.

So there's that teamwork thing again.

I tako, opet se tu pojavio onaj timski rad.

And we eventually discovered molecules

Na kraju smo otkrili molekule

that were specifically labeling nerves.

koje specifično obilježavaju živce.

And when we made a solution of this,

Kad smo napravili otopinu tih molekula,

tagged with the fluorescence

obilježenih fluorescentnim bojama,

and injected in the body of a mouse,

i ubrzgali ih u tijelo miša,

their nerves literally glowed.

njihovi živci doslovno su sjali.

You can see where they are.

Možete vidjeti gdje se oni nalaze.

Here you're looking at a sciatic nerve of a mouse,

Ovdje vidite ishijadični živac miša

and you can see that that big, fat portion you can see very easily.

i taj veliki dio vrlo je lako uočiti.

But in fact, at the tip of that where I'm dissecting now,

Ali zapravo, na vrhu gdje ja trenutno režem,

there's actually very fine arborizations

nalaze se vrlo fini ogranci

that can't really be seen.

koji se baš i ne mogu vidjeti.

You see what looks like little Medusa heads coming out.

Vidite nešto što izgleda poput malih Meduzinih glava.

We have been able to see nerves

Sada smo u mogućnosti vidjeti živce

for facial expression, for facial movement, for breathing --

odgovorne za izraze lica, pokrete lica, disanje --

every single nerve --

živce, sve do jednoga --

nerves for urinary function around the prostate.

živce za mokraćnu funkciju koji se nalaze oko prostate.

We've been able to see every single nerve.

U mogućnosti smo vidjeti doslovno svaki živac.

When we put these two probes together ...

Kada stavimo ove dvije sonde zajedno…

So here's a tumor.

Evo ga, tumor.

Do you guys know where the margins of this tumor is?

Znate li gdje su rubovi ovog tumora?

Now you do.

Sada znate.

What about the nerve that's going into this tumor?

Što je sa živcem koji ulazi u tumor?

That white portion there is easy to see.

Onaj bijeli ogranak lako je vidjeti.

But what about the part that goes into the tumor?

Ali što s dijelom koji ulazi u tumor?

Do you know where it's going?

Znate li gdje se on nalazi?

Now you do.

Sada znate.

Basically, we've come up with a way

Doslovno smo pronašli način

to stain tissue

da obojimo tkivo

and color-code the surgical field.

i bojama označimo kirurško polje.

This was a bit of a breakthrough.

To je na neki način veliko otkriće.

I think that it'll change the way that we do surgery.

Mislim da će ono promijeniti način na koji funkcionira kirurgija.

We published our results

Objavili smo rezultate

in the proceedings of the National Academy of Sciences

u radovima s Nacionalne akademije znanosti

and in Nature Biotechnology.

i u časopisu "Nature Biotechnology".

We received commentary in Discover magazine,

Komentirali su nas u časopisima "Discover"

in The Economist.

i "The Economist".

And we showed it to a lot of my surgical colleagues.

Pokazali smo to i mnogim mojim kolegama kirurzima.

They said, "Wow!

Rekli su: "Wow!

I have patients

Imam pacijente

who would benefit from this.

kojima bi ovo pomoglo.

I think that this will result in my surgeries

Mislim da će pomoću ovoga

with a better outcome

moje operacije imati bolje ishode

and fewer complications."

i manje komplikacija."

What needs to happen now

Ono što se sada treba dogoditi,

is further development of our technology

jest daljnje napredovanje naše tehnologije

along with development

zajedno s napredovanjem

of the instrumentation

instrumenata

that allows us to see

koji nam omogućavaju da vidimo

this sort of fluorescence in the operating room.

tu fluorescenciju u operacijskoj sali.

The eventual goal

Krajnji cilj je

is that we'll get this into patients.

primijeniti to na pacijentima.

However, we've discovered

No, otkrili smo

that there's actually no straightforward mechanism

da zapravo ne postoji izravan mehanizam

to develop a molecule

za razvitak molekule

for one-time use.

za jednokratnu upotrebu.

Understandably, the majority of the medical industry

Razumljivo, većina medicinske industrije

is focused on multiple-use drugs,

usredotočena je na lijekove za višestruko korištenje,

such as long-term daily medications.

poput dugoročnih, svakodnevnih lijekova.

We are focused on making this technology better.

Mi smo usredotočeni na poboljšanje ove tehnologije.

We're focused on adding drugs,

Usmjereni smo na dodavanje lijekova,

adding growth factors,

čimbenika rasta,

killing nerves that are causing problems

uništavanje živaca koji kompliciraju situaciju,

and not the surrounding tissue.

a ne okolno tkivo.

We know that this can be done and we're committed to doing it.

Znamo da se to može postići i posvećeni smo tom cilju.

I'd like to leave you with this final thought.

Htjela bih završiti s ovom posljednjom mišlju.

Successful innovation

Uspješne inovacije

is not a single breakthrough.

nisu pojedinačna otkrića.

It is not a sprint.

Nisu utrka.

It is not an event for the solo runner.

Nisu događaji za solo trkače.

Successful innovation

Uspješne inovacije

is a team sport, it's a relay race.

timski su sport, štafeta.

It requires one team for the breakthrough

One zahtijevaju jedan tim koji će omogućiti veliko otkriće

and another team

i drugi tim

to get the breakthrough accepted and adopted.

koji će omogućiti prihvaćanje i usvajanje tog otkrića.

And this takes the long-term steady courage

A to zahtjeva dugoročnu, čvrstu hrabrost

of the day-in day-out struggle

koja će se dan za danom boriti

to educate, to persuade

da educiraju, da uvjere

and to win acceptance.

i da dobiju pristanak.

And that is the light that I want to shine

I upravo to je svjetlost kojom želim osvijetliti

on health and medicine today.

zdravlje i današnju medicinu.

Thank you very much.

Hvala vam.

(Applause)

(Pljesak)