Dr. Kim Solez presents Update on the "Technology and Future of Medicine Course: Space, Regenerative Medicine, Large Touch Screens, and Leonard Cohen" on September 25, 2014 at Lab Medicine Pathology Grand Rounds at the University of Alberta in Edmonton, Canada.

1. Kim Solez, MD

2. 1. I do not have any conflict of interest and do not discuss any
off-label use of drugs or devices.

3. 1. To show how the LABMP 590 course - Technology
and the Future of Medicine - is morphing and
changing to remain relevant, including the new
areas of space, regenerative medicine, and large
interactive touch screens.
2. To show, counterintuitively, how resistance to new
ideas and nostalgia for the past can be beneficial
in the consideration of changes brought about by
regenerative medicine and stem cell biology.
3. To update progress since my last Grand Rounds
presentation on the course Dec. 13,
2012:https://www.youtube.com/watch?v=BjOIzbR
_X3Y
http://www.cybernephrology.ualberta.ca/misc/sol
ez/lmp/

4. Who Am I?

5. Who Am I?

7. Histologic criteria for the diagnosis of rejection and
other conditions in the transplanted kidney, began
1991, updated and expanded every two years in
consensus meeting.

8.  1991 First Conference
 1993 First Kidney International publication
 1995 Integration with CADI
 1997 Integration with CCTT classification
 1999 Second KI paper. Clinical practice guidelines. Implantation biopsies.
 2001 Classification of antibody-mediated rejection: Regulatory agencies
participating
 2003 Genomics focus, ptc cell accumulation scoring
 2005 Gene chip analysis. Elimination of CAN, identification of chronic
antibody-mediated rejection.
 2007 First meeting far from a town called “Banff” – La Coruna, Spain.
 2009 Working groups. Meeting in Banff, Alberta, Canada
 2013 Establishment of Banff Foundation for Allograft Pathology

9. • 4244 citations of the 9 Banff meeting reports
• 790 Banff / Transplantation papers in PubMed
• Banff 2003 meeting report (ABMR criteria) = most cited AJT paper
• 3 Banff meeting reports are among the top 4 cited AJT articles

10. Board of Trustees:
K. Solez (Chair), L. Racusen, D. Glotz, J. Demetris, M. Mengel, M. Mihatsch, D. Seron, N.
Schmidt
2015 Scientific program committee:
Alex Loupy (Chair)
Mark Haas, Banu Sis, Kathryn Tinkham, Candice
Rofousse, Chris Bellamy, Lynn Cornell, Carmen
LeFaucheur
Composite tissues: Linda Cendales
Heart : Rene Rodriguez
Liver: Jake Demetris
Lung: William Wallace and Carol Farver
Pancreas/Islets: Cinthia Drachenberg and John
Papadimitriou
progress
reports to Budged
2015 Local Conference
chair: Michael Mengel
reports to
Secretary/Treasurer:
Michael Mengel
reports to
Organ Steering committee
Chairs:
Composite tissues: Linda Cendales
Heart : Rene Rodriguez
Kidney: Mark Haas
Liver: Jake Demetris
Lung: William Wallace and Carol
Farver
Pancreas: Cinthia Drachenberg
funding
collaboration
collaboration
Banff Working Group (BWG) Leads:
Molecular transplantation pathology: Michael Mengel, Banu Sis
Isolated v-lesions: Banu Sis, Ed Kraus
Quality assurance in transplantation diagnostics: Michael Mengel and
Parmjeet Randhawa
C4d-negative ABMR: Mark Haas, Banu Sis, Alexandre Loupy
Fibrosis scoring: Robert Colvin, Brad Farris, Michael Mengel
Digital Pathology in Transplantation: Jake Demetris
collaboration
reports to
collaboration
proposal and
accountability
for meeting
costs
support

13. The Banff Process
Consensus communication in renal transplantation
a
The Banff
lesions
g, i, t, v - score
The Banff
community
Pathologists
Nephrologists
Tx-Surgeons
Lab-Medicine
established by
consensus in 1991
The Banff
classification
Current consensus for
diagnostics
moderated
Banff meetings
thesis-antithesis-synthesis
tentative
thresholds
participate
Banff Working refinement
Groups
Feedback concerning weaknesses and strengths by results
from independent research
New members
Biostaticians
Molecular Biologists
“Omics”-specialists
Off-springs
Liver
Pancreas
Lung, Heart
CTA

15. The technological singularity occurs as artificial
intelligences surpass human beings as the smartest
and most capable life forms on the Earth.
Technological development is taken over by the
machines, who can think, act and communicate so
quickly that normal humans cannot even comprehend
what is going on. The machines enter into a "runaway
reaction" of self-improvement cycles, with each new
generation of A.I.s appearing faster and faster. From
this point onwards, technological advancement is
explosive, under the control of the machines, and
thus cannot be accurately predicted (hence the term
"Singularity"). – Ray Kurzweil

17. Course conceptualized in
March 2011, tested with
focus groups in
May for its suitability as a
course for both
undergraduate and
graduate students.

18.  Ten minute introduction
 Fifty minute lecture
 Twenty minute discussion
 In the course we talk about
machines replacing many of the
functions of human beings. This
picture was taken by a machine
without human intervention, as
were many of the best still
images from the course. The
video camera is constantly
comparing the scene to
algorithms and takes still
pictures when the requirements
of the interesting picture
algorithm are satisfied.

19. First teaching session 2011 Recent teaching session 2014
Hot-linked tables of contents in YouTube video descriptions allow one
to jump right to content of interest.

22.  We endeavor to shoot broadcast quality video of
each lecture and discussion.
 Previous lectures on YouTube.com at
/user/KimSolez and /user/avoca99 . Students
are asked to critique one past lecture, and
suggest improvements in presentation and hot-linked
table of contents (20% of grade).
 Students write one 3,000 word paper (40%) and
give 20 min. presentation on same subject
(30%). Also graded on class participation (10%).
 No required reading. Suggested reading list in
course outline, readings suggested by Email.

23.  The technological Singularity. Existential
risks, AI, genomics, and nanotech.
 Ways to optimize a positive outcome for
humanity in the co-evolution of humans
and machines . The influence of these
considerations on medicine of the future.
 Prominent people internationally. Most
lectures not very “medical”. Easily
understood.
 Balanced view provided by incorporating
both tech skeptics and tech advocates.

24.  Nova program on PBS Television (7 million viewers)
 Doctor Who (BBC, 12 million viewers)
 Big Bang Theory (the TV show; 20 million viewers)
 Singularity Summit (9,000 views per video)
 Kim Solez – Technology and Future of Medicine Course
LABMP 590 (2,600 views per video)

26.  Medical student elective participation in course.
 International peer review of YouTube videos, modifications made.
Two Quantum Biology lectures.
 Collaboration with Social Media in Medicine course in Budapest,
Hungary, the only other course somewhat like this one.
 Stem cell, regenerative medicine aspects.
 Space exploration aspects.
 Large touch screen pathology aspects.
 Leonard Cohen the cohesion binding elements together, he
commented on AI&Sony Aibo Robotic dog during 2005 visit .
 Edmonton Leonard Cohen Event planned for 2016, larger
than 2008 event. AP Midsummer Fest will benefit. Attended
2014 LC event in Dublin, visited Fimmic touch screen offices.

27. The Technological
Singularity

28.  There were YouTube videos (now removed) suggesting
that stem cell generation of complex organs in humans
would be routine by 2020. Problems of clotting, endothelial
loss, and cell type selection errors not mentioned.
 The dramatic slowdown of new drug approvals (Eroom’s
Law) by the FDA suggests that the FDA is ripe for
disruptive innovation. Has started to happen.
 However stem cell therapies may be the last area the FDA
will relax regulation in, as unproven bogus stem cell
therapies are causing widespread suffering and protection
of the general public is needed.

30.  The recellularized organ clots like crazy, impossible to
regenerate more than 80% of endothelial surface. Artificial
heparized surface not fenestrated. Cell traffic abnormal.
 Hard to get right types of cells to right places.
 Podocytes seems to be terminally differentiated cells,
when attempt to culture them they turn into different type of
cell.
 Kidney progenitor stem cell difficult to identify, kidney work
has lagged behind.
 Easy to make stem cell generated kidneys that lack loop of
Henle. Could produce lethal polyuria. What is “function”?
 Many old fashioned questions of physiology about how the
stem cell generated organ works, not just true for kidney,
true for every organ. Do nephrons lacking loops of Henle
contribute to final urine? Nostalgia for “old questions”!

31.  Transplant
pathologists will also
become tissue
engineering
pathologists,
pathologists who
analyze organs grown
from stem cells. This is
not something beyond
us, we can adapt to a
work life that includes
stem cells. Someone
needs to cross the
disciplines, why not
us?

32.  Many of the questions
that need to be posed
about stem cell
generated organs are old
fashioned questions,
intact nephron
hypothesis, cell
regeneration, stunned
myocardium, contraction
band necrosis etc. Use
your nostalgia! Stimulate
conversations between
stem cell researchers and
transplant physicians.

41.  It is amazing how much of a "relationship“
you can strike up with the Sony Aibo
robotic dog despite the fact production
ended in 2005. Imagine what their
capabilities would be today if Sony had
continued developing them over the past 9
years!

44.  The only way I could get one in 2003 and
2004 was to fly to the US stay in a hotel
just long enough for the product to be
delivered and then fly back home, they
were impossible to get in Canada after
2002 through regular Sony channels here
as there was not a market among
Canadian consumers.

45.  A child quickly deconstructs them to a
point where they look quite ugly and
incomplete. The main market in the US
and Japan was affluent young women.

49.  We need the mainstream public to regard the
coming Technological Singularity as fact, not
fiction.
 We need to promote organized thinking about
the future in Universities and beyond.
 We need to think of all the ways to increase our
reach from this one course to the world at large.
 There are components of this lecture in which
you can become directly involved!