Quyen Nguyen: Color-coded surgery

Prevodilac: Jelena Nedjic Lektor: Ana Zivanovic-Nenadovic

I want to talk to you

Želim da sa vama podelim priču o

about one of the biggest myths in medicine,

jednom od najvećih mitova u medicini,

and that is the idea

koji je uobličen idejom da je

that all we need are more medical breakthroughs

neophodno doći do još više otkrića u medicini

and then all of our problems will be solved.

i tada će svi naši problemi biti rešeni.

Our society loves to romanticize

Našem društvu se sviđa romantičarska

the idea of the single, solo inventor

ideja o jednom usamljenom istraživaču koji

who, working late in the lab one night,

radeći do kasno u noć u laboratoriji

makes an earthshaking discovery,

dolazi do otkrića koje menja svet,

and voila, overnight everything's changed.

i juhu, sve se promeni preko noći.

That's a very appealing picture,

Ta slika je veoma privlačna,

however, it's just not true.

međutim nije istinita.

In fact, medicine today is a team sport.

Činjenica je da je medicina danas timski sport.

And in many ways,

Na mnogo načina je to

it always has been.

oduvek i bila.

I'd like to share with you a story

Želela bih da vam ispričam priču

about how I've experienced this very dramatically

o dramatičnom načinu na koji sam ja to doživela

in my own work.

u svom radu.

I'm a surgeon,

Ja sam hirurg,

and we surgeons have always had

a mi hirurzi smo uvek imali poseban

this special relationship with light.

odnos prema svetlosti.

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

Kada napravim rez unutar tela pacijenta, veoma je mračno.

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

Neophodno je da osvetlimo to polje kako bismo videli šta radimo.

And this is why, traditionally,

Zbog toga su tradicionalno operacije

surgeries have always started so early in the morning --

uvek počinjale rano ujutru,

to take advantage of daylight hours.

kako bi se iskoristila dnevna svetlost.

And if you look at historical pictures

Ukoliko pogledate stare fotografije

of the early operating rooms,

prvih operacionih sala,

they have been on top of buildings.

one su bile na krovovima zgrada.

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

Na primer, ovo je najstarija operaciona sala na zapadu,

in London,

u Londonu,

where the operating room

a operaciona sala se

is actually on top of a church

u principu nalazi u krovu crkve

with a skylight coming in.

gde dnevna svetlost lako prodire.

And then this is a picture

Ovo je slika jedne od

of one of the most famous hospitals in America.

najpoznatijih bolnica u Americi.

This is Mass General in Boston.

To je "Mass General" bolnica u Bostonu.

And do you know where the operating room is?

Da li znate gde je ovde operaciona sala?

Here it is

Ovde je

on the top of the building

na vrhu zgrade

with plenty of windows to let light in.

osvetljena dnevnom svetlošću.

So nowadays in the operating room,

Danas nam nije neophodna dnevna svetlost

we no longer need to use sunlight.

u operacionim salama.

And because we no longer need to use sunlight,

Obzirom da više ne moramo da koristimo dnevnu svetlost,

we have very specialized lights

posedujemo veoma posebna svetla

that are made for the operating room.

koja su napravljena za operacione sale.

We have an opportunity

Imamo mogućnosti da

to bring in other kinds of lights --

instaliramo različite vrste svetlosti,

lights that can allow us to see

svetlost koja nam omogućava da vidimo

what we currently don't see.

ono što trenutno ne možemo da vidimo.

And this is what I think

U tome se krije, ja mislim,

is the magic of fluorescence.

magija fluorescencije.

So let me back up a little bit.

Objasniću vam to malo.

When we are in medical school,

U toku studija medicine

we learn our anatomy from illustrations such as this

mi učimo anatomiju iz ilustracija kao što su ove,

where everything's color-coded.

gde je sve obeleženo bojama.

Nerves are yellow, arteries are red,

Nervi su žute boje, arterije su crvene,

veins are blue.

vene su plave.

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

To je toliko lako da bi svako mogao da bude hirurg, zar ne?

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

Međutim, kada pravi pacijent leži na stolu,

this is the same neck dissection --

ovo je ista ta disekcija vrata,

not so easy to tell the difference

nije tako lako uočiti razliku

between different structures.

među različitim strukturama.

We heard over the last couple days

Čuli smo nekoliko puta u toku proteklih dana

what an urgent problem

da je rak veoma hitan problem

cancer still is in our society,

u našem društvu,

what a pressing need it is

da je zaista neophodno

for us to not have

da smanjimo stopu smrtnosti

one person die every minute.

od jedne osobe u minuti.

Well if cancer can be caught early,

Ukoliko se rak dijagnozira rano,

enough such that someone can have their cancer taken out,

toliko rano da se rak može izvaditi iz tela,

excised with surgery,

operaciijom,

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

ne zanima me da li ima ovaj ili onaj gen,

or if it has this protein or that protein,

ili ima ovaj ili onaj protein,

it's in the jar.

nalazi se u tegli.

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

Završeno je, izvađen je, izlečen si od raka.

This is how we excise cancers.

Ovako vadimo tkivo raka.

We do our best, based upon our training

Mi damo sve od sebe, na osnovu onoga što znamo

and the way the cancer looks and the way it feels

i toga kako rak izgleda, kako se pacijent oseća,

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

na osnovu odnosa raka i ostalih organa i našeg iskustva,

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

kažemo, znate šta, rak je uklonjen.

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

Uradili smo dobar posao. Izvadili smo ga.

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

To je ono što hirurg kaže pacijentu

when the patient's on the table.

koji leži na operacionom stolu u sali.

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

Mi u tom trenutku u stvari ne znamo da li smo sve izvadili.

We actually have to take samples from the surgical bed,

Moramo uzeti uzorak tkiva sa operacije,

what's left behind in the patient,

uzorak koji je u pacijentu,

and then send those bits to the pathology lab.

i moramo to poslati patolozima na analizu.

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

Pacijent je u međuvremenu na operacionom stolu.

The nurses, anesthesiologist, the surgeon,

Medicinske sestre, anesteziolog, hirurg,

all the assistants are waiting around.

pomoćno osoblje - svi čekaju.

And we wait.

I mi čekamo.

The pathologist takes that sample,

Patolog dobije uzorak,

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

zamrzne ga, iseče, pogleda pod mikroskopom jedan po jedan slajd

and then calls back into the room.

i pozove operacionu salu.

And that may be 20 minutes later per piece.

Potrebno je oko 20 minuta po uzorku.

So if you've sent three specimens,

Ukoliko ste poslali tri uzorka,

it's an hour later.

čekate sat vremena.

And very often they say,

Veoma često kažu,

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

"Znate šta, tačke A i B su u redu,

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

ali na tački C i dalje imate ostatke tkiva raka.

Please go cut that piece out."

Molim vas uklonito to."

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

Tako da mi to uradimo ponovo, i onda još jednom.

And this whole process:

Ceo taj proces:

"Okay you're done.

"U redu, završili smo.

We think the entire tumor is out."

Mislimo da smo izvadili ceo tumor."

But very often several days later,

Veoma često nekoliko dana

the patient's gone home,

nakon što pacijent ode kući,

we get a phone call:

dobijemo telefonski poziv:

"I'm sorry,

"Izvinite,

once we looked at the final pathology,

kada smo pogledali krajnje patološke analize,

once we looked at the final specimen,

kada smo pogledali poslednji uzorak,

we actually found that there's a couple other spots

pronašli smo da je ostalo još nekoliko tačaka

where the margins are positive.

gde su obrisi pozitivni.

There's still cancer in your patient."

I dalje ima ćelija raka u pacijentu."

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

Tako da se sada suočavate sa tim da pre svega

that they may need another surgery,

treba da kažete pacijentu da mu je možda potrebna još jedna operacija,

or that they need additional therapy

ili da im je neophodna dodatna terapija

such as radiation or chemotherapy.

u vidu radio - ili hemo-terapije.

So wouldn't it be better

Zar ne bi bilo bolje

if we could really tell,

ako bismo zaista mogli da procenimo,

if the surgeon could really tell,

ako bi hirurg zaista mogao da tvrdi

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

da li je ili nije prisutno tkivo raka u operacionom polju?

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

Iz mnogo uglova, način na koji mi to radimo je takav

we're still operating in the dark.

da mi i dalje operišemo u tami.

So in 2004, during my surgical residency,

Dok sam bila na hirurškom usavršavanju 2004.

I had the great fortune

imala sam veliku sreću

to meet Dr. Roger Tsien,

da upoznam dr Rodžera Čena,

who went on to win the Nobel Prize for chemistry

koji je kasnije dobio Nobelovu nagradu

in 2008.

za hemiju 2008.

Roger and his team

Rodžer i njegov tim

were working on a way to detect cancer,

su istraživali načine detekcije raka,

and they had a very clever molecule

i pronašli su

that they had come up with.

veoma pametan molekul.

The molecule they had developed

Molekul do kojeg su došli

had three parts.

je imao tri dela.

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

Njegov glavni deo je u plavoj boji, to je polikatjon,

and it's basically very sticky

i lako se lepi za

to every tissue in your body.

bilo koje tkivo u telu.

So imagine that you make a solution

Zamislite da napravite rastvor koji je

full of this sticky material

zasićen ovim lepljivim materijalom

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

i da to ubrizgate u vene osobe koja boluje od raka,

everything's going to get lit up.

sve će biti osvetljeno.

Nothing will be specific.

Ništa nije specifično.

There's no specificity there.

Tu ne postoji specifičnost.

So they added two additional components.

Ubacili su još dva dodatna dela.

The first one is a polyanionic segment,

Prvi deo je polianjonski dodatak,

which basically acts as a non-stick backing

koji prosto deluje kao zaštitni papir

like the back of a sticker.

na poleđini nalepnice.

So when those two are together, the molecule is neutral

Kada su ovi delovi zajedno, molekul je neutralan

and nothing gets stuck down.

i ništa se za to ne vezuje.

And the two pieces are then linked

Ova dva dela su povezana nečim

by something that can only be cut

što može biti odsečeno

if you have the right molecular scissors --

ukoliko imate ispravne molekularne makaze -

for example, the kind of protease enzymes

na primer, tip proteaze-enzima

that tumors make.

koji proizvode tumori.

So here in this situation,

U ovom rastvoru,

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

ukoliko napravite rastvor zasićen ovim trodelnim molekulima

along with the dye, which is shown in green,

zajedno sa bojom, koja je prikazana u zelenom,

and you inject it into the vein

i to ubrizgate u venu

of someone who has cancer,

nekoga ko boluje od raka

normal tissue can't cut it.

zdravo tkivo to ne može da procesuje.

The molecule passes through and gets excreted.

Molekul prođe kroz sistem i telo ga izbaci.

However, in the presence of the tumor,

Međutim, ako se tu nalazi tumor

now there are molecular scissors

tada su tu i molekularne makaze

that can break this molecule apart

koje mogu da rastave ovaj molekul

right there at the cleavable site.

baš tu gde se molekul može preseći.

And now, boom,

Sada, tras,

the tumor labels itself

tumor sam sebe obeleži

and it gets fluorescent.

i postaje fluorescentan.

So here's an example of a nerve

Ovo je primer nerva oko kojeg

that has tumor surrounding it.

se nalazi tkivo tumora.

Can you tell where the tumor is?

Da li možete da vidite gde je tumor?

I couldn't when I was working on this.

Ja nisam mogla kada sam radila na ovome.

But here it is. It's fluorescent.

Ali ovde je. Fluorescentan je.

Now it's green.

Sada je zelen.

See, so every single one in the audience

Vidite, sada svako u publici može

now can tell where the cancer is.

da kaže gde se rak nalazi.

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

Možemo na licu mesta, u operacionoj sali,

at a molecular level,

na molekularnom nivou,

where is the cancer and what the surgeon needs to do

uočiti gde je locirano tkivo raka i hirurg zna šta treba da uradi

and how much more work they need to do

i koliko ima posla oko

to cut that out.

odstranjivanja tumora.

And the cool thing about fluorescence

Dobra osobina fluorescencije je da,

is that it's not only bright,

ne samo da je svetla,

it actually can shine through tissue.

već svetli i kroz tkivo.

The light that the fluorescence emits

Svetlost koju fluorescencija emituje

can go through tissue.

prolazi kroz tkivo.

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

Tako da čak ako tumor nije na samoj površini

you'll still be able to see it.

i dalje ćete moći da ga uočite.

In this movie, you can see

U ovom filmu možete videti

that the tumor is green.

da je tumor zelene boje.

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

Preko njega se nalazi normalan mišić. Vidite li to?

And I'm peeling that muscle away.

Ja odstranjujem mišić.

But even before I peel that muscle away,

Ali čak i pre nego što uklonim taj mišić,

you saw that there was a tumor underneath.

videli ste tkivo tumora ispod njega.

So that's the beauty of having a tumor

U tome se nalazi lepota toga što je tumor

that's labeled with fluorescent molecules.

obeležen fluorescentnim molekulima.

That you can, not only see the margins

U tom slučaju možete ne samo da vidite

right there on a molecular level,

ivice na molekularnom nivou,

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

već ga možete uočiti iako nije na samom vrhu -

even if it's beyond your field of view.

iako je izvan vašeg vidnog polja.

And this works for metastatic lymph nodes also.

Ovo se može primeniti i u slučaju metastaza limfnih čvorova.

Sentinel lymph node dissection

Operacija senzornih limfnih čvorova je

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

ne tako davno promenila način lečenja raka dojke, melanoma.

Women used to get

Žene su bile podvrgavane

really debilitating surgeries

operacijama koje su ih onesposobljavale

to excise all of the axillary lymph nodes.

i putem kojih su im izvađeni svi pazušni limfni čvorovi.

But when sentinel lymph node

Kada su senzorni limfni čvorovi

came into our treatment protocol,

uvedeni u procedure lečenja,

the surgeon basically looks for the single node

hirurg u principu traži tačno određeni čvor

that is the first draining lymph node of the cancer.

koji je prvi drenažni limfni čvor tkiva raka.

And then if that node has cancer,

Ukoliko ima ćelija raka u čvoru,

the woman would go on to get

žena bi bila podrvgnuta

the axillary lymph node dissection.

operaciji pazušnih limfnih čvorova.

So what that means

To prosto znači da žene

is if the lymph node did not have cancer,

ne bi prolazile kroz nepotrebne operacije

the woman would be saved

ukoliko se rak nije proširio

from having unnecessary surgery.

na limfne čvorove.

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

Senzorni limfni čvorovi i način na koji to radimo danas

is kind of like having a road map

su bukvalno nešto kao mapa puta

just to know where to go.

kako biste znali gde da idete.

So if you're driving on the freeway

Ukoliko se vozite auto-putem

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

i želite da znate lokaciju sledeće benzinske pumpe,

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

vi imate mapu koja vam kaže gde se ta pumpa nalazi.

It doesn't tell you whether or not

Ne govori vam ništa o tome

the gas station has gas.

da li ima ili nema benzina.

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

Morate da je isečete, donesete kući,

cut it up, look inside

secirate, analizirate,

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

i zaključite: "Da, ima goriva."

So that takes more time.

To traži više vremena.

Patients are still on the operating room table.

Pacijenti su i dalje na operacionom stolu.

Anesthesiologists, surgeons are waiting around.

Anesteziolozi i hirurzi prosto čekaju.

That takes time.

Za to je potrebno vreme.

So with our technology, we can tell right away.

Uz pomoć naše tehnologije, mi to odmah možemo da saznamo.

You see a lot of little, roundish bumps there.

Vidite ovde mnogo malih, okruglastih izbočina.

Some of these are swollen lymph nodes

Neke od njih su natečeni limfni čvorovi

that look a little larger than others.

koji deluju veće od drugih.

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

Ko od nas nema natečene limfne čvorove kada se prehladi?

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

To ne znači da su unutar njih ćelije raka.

Well with our technology,

Uz pomoć naše tehnologije,

the surgeon is able to tell immediately

hirurzi odmah mogu proceniti

which nodes have cancer.

u kojim čvorovima ima ćelija raka.

I won't go into this very much,

Ne bih previše dataljisala o ovome,

but our technology, besides being able

ali pored toga što je naša tehnologija u stanju

to tag tumor and metastatic lymph nodes with fluorescence,

da obeleži tumor i limfni čvor sa metastazama fluorescencijom,

we can also use the same smart three-part molecule

ona nam omogućava i da koristimo isti onaj pametan trodelni molekul

to tag gadolinium onto the system

kako bismo dodali gadolinijum u sistem

so you can do this noninvasively.

i radili sve to neinvazivnim postupkom.

The patient has cancer,

Pacijent boluje od raka,

you want to know if the lymph nodes have cancer

vi želite da znate da li su limfni čvorovi zaraženi

even before you go in.

pre nego što otvorite pacijenta.

Well you can see this on an MRI.

To možete uraditi uz pomoć MRI tehnologije.

So in surgery,

Važno je znati u toku operacije

it's important to know what to cut out.

šta treba odstraniti.

But equally important

Isto toliko je važno

is to preserve things

sačuvati strukture

that are important for function.

koje su značajne za funkcionisanje.

So it's very important to avoid inadvertent injury.

Tako da je veoma važno izbegavati povrede nastale iz nepažnje.

And what I'm talking about

Sada govorim

are nerves.

o nervima.

Nerves, if they are injured,

Ukoliko povredimo nerve

can cause paralysis,

može doći do paralize,

can cause pain.

uzrokuju bol.

In the setting of prostate cancer,

U slučaju raka prostate,

up to 60 percent of men

čak i do 60 odsto muškaraca

after prostate cancer surgery

nakon operacije prostate

may have urinary incontinence

gubi kontrolu nad bešikom

and erectile disfunction.

i doživljava probleme sa erekcijom.

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

To je mnogo ljudi koji imaju puno problema,

and this is even in

a ovo je čak

so-called nerve-sparing surgery,

nešto što zovemo zahvat koji štiti nerve,

which means that the surgeon is aware of the problem,

što znači da su hirurzi svesni problema

and they are trying to avoid the nerves.

i pokušavaju da zaobiđu nerve.

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

Znate li da su ovi mali nervi u okviru prostate

in the context of prostate cancer,

toliko mali

that they are actually never seen.

da nikada nisu uočeni.

They are traced

Pratimo ih samo

just by their known anatomical path

uz pomoć poznate anatomske putanje

along vasculature.

uz krvne sudove.

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

Za njh znamo jer je neko odlučio da ih izučava,

which means that we're still learning

što znači da mi i dalje učimo

about where they are.

gde se oni nalaze.

Crazy to think that we're having surgery,

Ludo je pomisliti da radimo operaciju,

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

pokušavamo da otklonimo rak, a ne znamo gde se nalazi.

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

Pokušavamo da sačuvamo nerve, a ne možemo da uočimo gde su.

So I said, wouldn't it be great

Zapitala sam, se zar ne bi bilo sjajno

if we could find a way

kada bih pronašla način

to see nerves with fluorescence?

da vidim nerve uz pomoć fluorescencije?

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

U početku nismo naišli na mnogo podrške.

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

Ljudi bi rekli: "Radili smo to na ovaj način godinama.

What's the problem?

U čemu je problem?

We haven't had that many complications."

Nismo imali toliko komplikacija."

But I went ahead anyway.

Ali sam ja bez obzira na to nastavila.

And Roger helped me.

Rodžer mi je pomogao.

And he brought his whole team with him.

Poveo je svoj ceo tim.

So there's that teamwork thing again.

Tako da je opet u pitanju timski rad.

And we eventually discovered molecules

Na kraju smo otkrili molekule

that were specifically labeling nerves.

koji specifično obeležavaju nerve.

And when we made a solution of this,

Kada smo napravili rastvor tog molekula

tagged with the fluorescence

i obeležili ga fluorescencijom,

and injected in the body of a mouse,

a potom to ubrizgali u telo miša,

their nerves literally glowed.

njihovi nervi su prosto blistali.

You can see where they are.

Možete videti gde su.

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

Ovde možete uočiti išijadični nerv miša,

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

i vidite da ovaj veliki, masni deo možete lako uočiti.

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

Ali, u suštini, na vrhu mesta gde vršim disekciju sada

there's actually very fine arborizations

se nalazi mesto gde dolazi do finog grananja nerva

that can't really be seen.

koje baš i nije lako uočiti.

You see what looks like little Medusa heads coming out.

Možete uočiti nešto nalik na glavu male Meduze koja se probija.

We have been able to see nerves

Uspeli smo da vidimo nerve koji kontrolišu

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

facijalnu ekspresiju, pokrete lica, disanje -

every single nerve --

svaki pojedinačni nerv -

nerves for urinary function around the prostate.

nerve koji kontrolišu urinarnu funkciju oko prostate.

We've been able to see every single nerve.

Mogli smo da uočimo svaki pojedinačni nerv.

When we put these two probes together ...

Pomešali smo ove dve probe i ...

So here's a tumor.

Ovo je tumor.

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

Da li znate gde su granice tumora?

Now you do.

Sada znate.

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

Šta je sa nervom koji ulazi u tumor?

That white portion there is easy to see.

Beličasti deo je lako uočiti.

But what about the part that goes into the tumor?

Šta se dešava sa delom koji ulazi u tumor?

Do you know where it's going?

Da li znate gde se pruža?

Now you do.

Sada znate.

Basically, we've come up with a way

U suštini pronašli smo način

to stain tissue

da obojimo tkivo

and color-code the surgical field.

i bojama obeležimo operativno polje.

This was a bit of a breakthrough.

To je podsećalo na otkirće.

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

Mislim da će to promeniti hirurgiju.

We published our results

Objavili smo naše rezultate u

in the proceedings of the National Academy of Sciences

"Proceedings of the National Academy of Sciences" (PNAS)

and in Nature Biotechnology.

i u "Nature Biotechnology" žurnal.

We received commentary in Discover magazine,

To je propraćeno u časopisu "Otkriće",

in The Economist.

i u "Ekonomistu".

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

Pokazali smo to mojim kolegama hirurzima.

They said, "Wow!

Rekoše: "Sjajno!"

I have patients

Moji pacijenti bi mogli

who would benefit from this.

da imaju koristi od ovoga.

I think that this will result in my surgeries

Mislim da će ovo rezultirati u

with a better outcome

boljim ishodima operacija

and fewer complications."

i manje komplikacija."

What needs to happen now

Sada je neophodno da dođe do

is further development of our technology

daljeg razvijanja naše tehnologije

along with development

koju bi pratio razvoj

of the instrumentation

neophodnih instrumenata

that allows us to see

koji bi nam omogućio da vidimo

this sort of fluorescence in the operating room.

ovaj tip fluorescencije u operacionoj sali.

The eventual goal

Krajni cilj jeste da

is that we'll get this into patients.

na ovaj način pomognemo pacijentima.

However, we've discovered

Međutim, otkrili smo da

that there's actually no straightforward mechanism

u principu ne postoji jednostavan mehanizam

to develop a molecule

kojim bismo sintetisali molekul

for one-time use.

za jednokratnu upotrebu.

Understandably, the majority of the medical industry

Razumljivo je da je veliki deo medicinske industrije

is focused on multiple-use drugs,

fokusiran na lekove za višestruku upotrebu,

such as long-term daily medications.

kao što su dnevni lekovi koji se dugo koriste.

We are focused on making this technology better.

Posvećeni smo tome da tu tehnologiju unapredimo.

We're focused on adding drugs,

Posvećeni smo dodavanju lekova,

adding growth factors,

dodavanju hormona rasta,

killing nerves that are causing problems

ubijanju nerava koji uzrokuju probleme

and not the surrounding tissue.

ali ne i okolnog tkiva.

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

Znamo da se ovo može uraditi i posvećeni smo tom radu.

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

Želim da završim ovom mišlju.

Successful innovation

Uspešan izum nije

is not a single breakthrough.

jedno veliko otkriće.

It is not a sprint.

To nije sprint trka.

It is not an event for the solo runner.

To nije događaj za solo trkača.

Successful innovation

Uspešni pronalsci su rezultat

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

timskog sporta, štafete.

It requires one team for the breakthrough

Neophodan je jedan tim za otkriće

and another team

i drugi tim

to get the breakthrough accepted and adopted.

koji će otkriće učiniti prihvaćenim.

And this takes the long-term steady courage

Sve to zahteva dugotrajnu, nepokolebljivu hrabrost

of the day-in day-out struggle

za vođenje svakodnevne borbe

to educate, to persuade

da obrazujete, ubedite

and to win acceptance.

i konačno dođete do prihvatanja.

And that is the light that I want to shine

To je svetlost kojom želim

on health and medicine today.

da obasjam zdravstvo i medicinu današnjice.

Thank you very much.

Hvala vam mnogo.

(Applause)

(Aplauz)