Nobel prize for medicine goes to cancer therapy
Two scientists who discovered how to fight cancer using the body's immune system have won the 2018 Nobel Prize for physiology or medicine.
The work, by Professor James P Allison from the US and Professor Tasuku Honjo from Japan, has led to treatments for advanced, deadly skin cancer.
Immune checkpoint therapy has revolutionised cancer treatment, said the prize-giving Swedish Academy.
Experts say it has proved to be "strikingly effective".
Prof Allison, of the University of Texas, and Prof Honjo, of Kyoto University, will share the Nobel prize sum of nine million Swedish kronor - about $1.01 million or 870,000 euros.
Accepting the prize, Tasuku Honjo told reporters: "I want to continue my research ... so that this immune therapy will save more cancer patients than ever."
Prof Allison said: "It's a great, emotional privilege to meet cancer patients who've been successfully treated with immune checkpoint blockade. They are living proof of the power of basic science, of following our urge to learn and to understand how things work."
Treating the untreatable
Our immune system protects us from disease, but it has built-in safeguards to stop it from attacking our own tissue.
Some cancers can take advantage of those "brakes" and dodge the attack too.
Allison and Honjo, now both in their 70s, discovered a way to unleash our immune cells to attack tumours by turning off proteins that put the brakes on.
And that led to the development of new drugs which now offer hope to patients with advanced and previously untreatable cancer.
Immune checkpoint therapy is being used by the NHS to treat people with the most serious form of skin cancer, melanoma.
It doesn't work for everyone, but for some patients it appears to have worked incredibly well, getting rid of the tumour entirely, even after it had started to spread around the body.
Such remarkable results had never been seen before for patients like these.
Doctors have also been using the treatment to help some people with advanced lung cancer.
Prof Charles Swanton, from Cancer Research UK, congratulated the prize winners, saying: "Thanks to this groundbreaking work, our own immune system's innate power against cancer has been realised and harnessed into treatments that continue to save the lives of patients. For cancers such as advanced melanoma, lung, and kidney, these immune-boosting drugs have transformed the outlook for many patients who had run out of options.
"The booming field of immunotherapy that these discoveries have precipitated is still relatively in its infancy, so it's exciting to consider how this research will progress in the future and what new opportunities will arise."
in infancy幼い頃［とき］（に）in （one's） infancy始まったばかりで、初期の段階で
Medicine is the first of the Nobel Prizes awarded each year.
The literature prize will not be handed out this year, after the awarding body was affected by a sexual misconduct scandal.
EpiPen shortage 'worrying' for people with allergies
A shortage of EpiPens is causing worry for people with allergies in the UK.
The makers of the adrenaline injection pen, which is used to treat severe and life threatening allergic reactions, say the supply problems are due to manufacturing issues.
The Department of Health said they were working with the manufacturers to "resolve the supply situation as quickly as possible".
They said limited supplies were being closely managed.
"Any patient who is unable to obtain supplies should speak to their doctor about using an alternative adrenaline auto-injector device," said a government official.
EpiPen is the biggest of the adrenaline auto-injectors on the market and shortages have had a knock-on effect, cutting into the stocks of other AAIs Jext and Emerade.
Jacqueline Scoins Cass has 10 allergies, including dairy, latex and coconut, for which she needs to carry EpiPens.
It is recommended that people carry two pens as the first one may not work on its own. Jacqueline managed to get one EpiPen in April and was told she would receive a second one soon after.
It arrived on Friday.
She said the six months' wait had been a "worry" but she knew she was better off than other people she talked to on allergy forums.
"It's affecting people across the country," she said.
"People have been traipsing pharmacy to pharmacy to try and find them because they didn't even have the first pen - at least I knew I had one pen that was in date.
"It would be really worrying if you didn't have any at all - out-of-date adrenaline is better than no adrenaline but obviously these pens have a shelf life for a reason.
shelf life《a ～》〔食品・薬品などの品質が保たれる〕保存可能期間
"I really feel for the people who haven't got one.
"It's a life-and-death medication."
Robbie Turner, director of pharmacy at the Royal Pharmaceutical Society, advises:
Ask for your prescription in good time
Allow several weeks before it is required to give your pharmacist time to track down stock
Even though the expiry date will state a particular month, the device will be valid until the last day of that month
If you are prescribed a new brand, it's important to ask your pharmacist or another healthcare professional to show you how to use it, as there are slight differences between brands
Ensure anyone else who might use the device on you knows how to use it too
The charity Anaphylaxis Campaign says anyone anxious about their prescription should visit their GP and talk about it directly with them.
And do not dispose of any "expired" AAI devices before receiving a new one.
Even if a device is out-of-date, as long as the liquid inside is not cloudy or discoloured it can still be used in an emergency.
Jacqueline had to wait a month last year for her second pen and hopes the issues will have been sorted out by the time she needs to replace them next time.
She said: "Pens last a year or 18 months. So, if everyone's struggled to get them and they've all come in at a similar sort of time, they are all going to expire at the same time next year again. So, hopefully, they've future-planned that there's enough medication for then."
The shortage has affected people in the US, Canada and Australia as well as the UK.
Mylan, who market Epipen, said Pfizer was "working hard" to increase production and supply would stabilise towards the end of the year.
Electrical implant helps paralysed people to walk again
Kelly Thomas learned to walk again after doctors attached an electrical patch to her spinal cord
Three patients, all paralysed from the waist down, have been able to walk again after having an electrical patch fitted to their spinal cords.
Experts say the device, which is placed below the injury, helps lost signals from the brain reach the leg muscles.
US research teams at the University of Louisville and the Mayo Clinic, report the success in Nature Medicine and the New England Journal of Medicine.
One of the recipients says her life has been transformed by the technology.
Hope after accident
Kelly Thomas, 23, from Florida, is one of two patients at the University of Louisville who has been helped by the development, which has been combined with months of intense rehabilitation therapy.
She said: "Being a participant in this study truly changed my life, as it has provided me with a hope that I didn't think was possible after my car accident.
"The first day I took steps on my own was an emotional milestone in my recovery that I'll never forget, as one minute I was walking with the trainer's assistance and while they stopped, I continued walking on my own. It's amazing what the human body can accomplish with help from research and technology."
Jeff Marquis, who was injured in a mountain-biking accident, has also benefited.
The 35-year-old is now able to walk for himself with support either from a frame or from people on either side of him holding his hands.
A third patient, 29-year-old Jered Chinnock, was treated at the Mayo Clinic in collaboration with the University of California, Los Angeles.
He injured his spine in 2013 in a snowmobile accident. Since having the patch fitted he has been able to walk more than 100m with the support of a frame.
Jered Chinnock has walked 100m with his frame since using the implant
The patch does not repair the damage but circumvents it by stimulating nerves lower down in the spinal cord.
This appears to allow signals from the brain to reach the target muscles so the person can voluntarily control their own movements again.
When the stimulation was switched off again the conscious movement didn't happen.
Neurosurgeon Dr Kendall Lee, who co-led the team from the Mayo Clinic in Rochester, Minnesota, said: "It's very exciting, but still very early in the research stage."
Although there are many unanswered questions, including precisely how it works and who it might help, Dr Lee said: "It gives hope to people faced with paralysis."
Other scientists have had success in the past with mending spinal damage using cells.
Probiotics labelled 'quite useless'
Probiotics include yogurts that contain "good bacteria".
A group of scientists in Israel claim foods that are packed with good bacteria - called probiotics - are almost useless.
Their study is among the most detailed analyses of what happens when we consume probiotics.
They are seen as healthy and good for the gut, but the results found they had little or no effect inside the body.
The researchers said probiotics of the future would need tailoring to the needs of each individual.
tailor ~ to someone's needs（人）のニーズに合わせて～を作る
The team at the Weizmann Institute of Science made their own probiotic cocktail using 11 common good bacteria including strains of Lactobacillus and Bifidobacteria.
It was given to 25 healthy volunteers for a month.
They were then sedated and samples were surgically taken from multiple places in the stomach and small and large intestines.
The researchers were looking to see where bacteria successfully colonised and whether they led to any changes in the activity of the gut.
The results in the journal Cell, showed in half of cases the good bacteria went in the mouth and straight out the other end.
In the rest, they lingered briefly before being crowded out by our existing microbes.
You're more microbe than human - if you count all the cells in your body, only 43% are human
The rest is our microbiome and includes bacteria, viruses, fungi and single-celled archaea
The human genome - the full set of genetic instructions for a human being - is made up of 20,000 instructions called genes
But add all the genes in our microbiome together and the figure comes out at between two million and 20 million microbial genes
It's known as the second genome and is linked to diseases including allergy, obesity, inflammatory bowel disease, Parkinson's, whether cancer drugs work and even depression and autism
More than half your body is not human
Gut Instinct: Why I put my poo in the post
Does vaginal seeding boost health?
Why a faecal transplant could save your life
How bacteria are changing your mood
Trillions of bacteria call the lining of our guts home and everyone has a different mix of microbial inhabitants.
Dr Eran Elinav said it was wrong to expect an off-the-shelf probiotic to work for everyone.
He says that in the future probiotics will need to be tailored to the needs of individual patients.
He told the BBC: "And in that sense just buying probiotics at the supermarket without any tailoring, without any adjustment to the host, at least in part of the population, is quite useless."
The research group also looked at the impact of probiotics after a course of antibiotics, which wipe out both good and bad bacteria.
Their trial on 46 people, also in the journal Cell, showed it led to delays in the normal healthy bacteria re-establishing themselves.
Dr Elinav added: "Contrary to the current dogma that probiotics are harmless and benefit everyone, these results reveal a new potential adverse side effect of probiotic use with antibiotics that might even bring long-term consequences."
There have been some proven benefits of probiotics, notably in protecting premature babies from necrotising enterocolitis.
And there remains great hope within science that understanding the complex relationship between the microbial and human parts of our body will lead to new treatments.
However, Dr Trevor Lawley, a microbiome researcher at the Sanger Institute, said he was not surprised by the findings.
He told the BBC: "Probiotics have been around for a long time and they're coming under more scrutiny.
"These are very innovative studies, but they are preliminary findings that need replicating.
"The gut has a natural property to stop colonisation, as it usually blocks pathogens, and that is something we have to outmanoeuvre."
'I vomit 30 times a day' - Caitlin's dilemma
A teenager with a rare gut condition that causes her to vomit up to 30 times a day has described the difficult choices she faces.
Caitlin White, 19, from Perth, suffers from severe gastroparesis.
最近の米国からの報告では，一次性のGPと糖尿病性のGP（diabetic gastroparesis：DGP）の両者とも，胃の神経線維やカハール介在細胞（interstitial cells of Cajal：ICC）の減少，炎症細胞浸潤などの器質的変化が共通して認められることが明らかにされている
Her current treatment includes daily hospital-based infusions which can take up to 12 hours and risk infection.
She says another treatment could bypass her gut, but that also carries major risks.
Her condition basically means there is a delay in emptying her stomach, which causes her to vomit regularly.
Other conditions are also at play which effectively programme her body to be sick.
Caitlin described her complex condition to presenter Kirsty Wark on BBC Scotland's Kaye Adams radio programme.
She said: "My day-to-day life is dominated by hospital visits.
I wouldn't go out for a meal or coffee with my friends anymore because I would be very embarrassed
"I attend a hospital every day for blood checks and infusions which can last from four hours to eight hours.
"On the odd day it can last 12 hours, like it did yesterday (Sunday).
"I'm not allowed to drive because of the condition. I've also got postural tachycardia syndrome, so my heart rate tends to increase."
postural tachycardia syndrome
Caitlin first fell ill with the condition when she was 14 and when her weight was 11 stone.
She now weighs just six stone (38kg).
Over the past five years, the symptoms have become more acute and her treatment has had a major impact on her life.
She said: "The doctors can try anything up to 18 times to get a drip into my arm, because I've got such bad veinous access.
"Once they eventually get a drip in, my infusions run and then I go home.
I'm malnourished as it is, and there's (the risk of) organ failure as well
"I obviously eat and drink when I am at home and when I am at the hospital too.
"But I have had septicaemia seven times this year because I have got such a low immune system."
Her condition has totally changed her relationship with her friends, many of whom have moved on with their lives.
Caitlin said: "I wouldn't go out for a meal or coffee with my friends anymore because I would be very embarrassed.
"When I'm out I take containers or cups - I'm just not the same as my peers any more. They've went on to university and things.
"I still keep in touch through Snapchat and Facebook and things but I don't see them as much."
Image copyrightCAITLIN WHITE
Caitlin used to want to be a teacher or lawyer but now says she wants to travel or do something involved with medicine when she is better
Asked how the condition has changed her outlook, Caitlin said: "When I was younger I thought maybe (I wanted to be) a teacher, or maybe a lawyer.
"But now probably when I'm better I would hope to do something involved with medicine or travelling probably."
She was receiving treatment at Ninewells Hospital in Dundee but her care there ended. She now attends Perth Royal Infirmary.
Following an intervention by Scotland's chief medical officer, she recently saw a consultant in Glasgow who advised that total parenteral nutrition (TPN) may be a possible course of treatment.
total parenteral nutrition
'Lot of risks'
This would involve a line which delivers nutrients straight to the liver and bypasses the digestive system.
Caitlin described the predicament she now faces.
"There is a lot of risks associated with (TPN)," she told listeners.
"It's a Catch 22: if they decide to give me feed (into her gut) I'm at high risk of 're-feeding syndrome', infections and blood clots.
refeeding syndromeリフィーディング症候群 低栄養状態にあった者が栄養補給を受けた際に生じる代謝異常
"But if they don't do it, I am also at risk of infection. I'm malnourished as it is, and there's (the risk of) organ failure as well."
Dr Neil Jamieson, gastroenterologist at Raigmore Hospital in Inverness, said gastroparesis was a very difficult condition to treat.
He said: "Thankfully most of the people who have it aren't as severely affected as Caitlin.
"The majority of people have diabetes and the nerves are damaged in the stomach, and the stomach doesn't empty properly.
"But in these severe cases it is very difficult because often it affects young people who lose their independence. It's a very emotive area."
He said: "There are studies under way to look at medicines that might help improve the emptying of the stomach.
"But it's actually very difficult (when) the nervous system is affected - that tends to be one of the most complex of the systems to influence.
"It's a very complicated system in its own way - and to replicate that or just trigger it to work with medicines is very difficult.
"We really are looking to support people as much as we can when they have got such severe disease."
With no direct experience of Caitlin's case, he said doctors tended to view TPN - if it's going to be used in the long-term - as potentially "a last resort".
He said: "It's not something that is realistically achievable for many years without some risk of complication.
"The gut really is what we need to be feeding if at all possible because it keeps it healthy, and the risks of feeding into the gut are so much lower."
if at all possible可能なら
Asked what were her hopes for the future, Caitlin said: "In general, I just hope that my health will improve altogether.
"I would hope that someone would be willing to consider TPN and give it a try.
"Or (I hope) there's a specialist out there who knows how to reduce the vomiting.
"If the TPN was established, the vomiting wouldn't be as frequent because I wouldn't be taking in as much orally."
Aurea Vazquez Rijos: Beauty queen on trial for husband's murder
When a onetime beauty queen walks into a courtroom in Puerto Rico this week, it will bring to an end a long wait endured by relatives of her wealthy former husband, who was stabbed to death in the street.
Aurea Vazquez Rijos and Adam Joel Anhang's romance was short-lived and ill-starred.
Now, almost 13 years after Anhang's murder, a US federal court will finally decide whether the former beauty queen from Puerto Rico had her Canadian online gaming tycoon husband killed after just six months of marriage.
The trial, due to start on 21 August, only takes place after an extraordinary legal battle as Ms Vazquez fought extradition from both Italy and Spain.
It was the father of her late husband who used private detectives to track Ms Vazquez down in Italy after an innocent man had been jailed for the murder and later released.
"It took us five years and a lot of effort and energy to track her, since no sooner did we locate her, she got wind of it and moved on," Abe Anhang told the BBC from his home in Winnipeg, Canada.
Anhang, a 32-year-old real estate and gaming software multimillionaire, was brutally beaten and stabbed to death one September evening in 2005 on a street in the historical quarter of the Puerto Rican capital, San Juan.
At first glance, the attack appeared to be a robbery gone wrong in which Ms Vazquez Rijos was also injured by the male assailant.
But, according to prosecutors, Anhang was duped into believing that he was meeting his wife in a San Juan restaurant that evening to discuss the terms of their divorce, when in fact he was being lured into a fatal trap.
Ms Vazquez Rijos, the accusation holds, knew that divorce would deprive her of access to much of her husband's estate, estimated to be worth $24m (￡19m), due to a pre-nuptial agreement the pair had signed.
Two years later, Jonathan Roman Rivera, a kitchen worker from a nearby restaurant, was convicted of murdering Anhang in an opportunistic robbery.
That conviction was later overturned when a witness came forward, telling a US federal grand jury how she saw the killer hit Anhang with a street cobble stone and knife him several times.
He then spoke with Ms Vazquez briefly before striking her with moderate force, the witness added.
In 2008, a federal grand jury indicted Ms Vazquez on two murder-for-hire related counts after the man suspected of being the street assailant confessed to the killing.
In a statement read out before a court in San Juan, Alex "El Loco" Pabon Colon said that Ms Vazquez had agreed to pay him $3m when they discussed her husband's killing at Vazquez's Pink Skirt nightclub and restaurant, a business bought for her as a wedding present by Anhang.
"Aurea communicated with Alex to tell him to park his car in the San Justo street lot. Alex would do what he had to do," the signed confession reads.
But Ms Vazquez was no longer in US jurisdiction, having abandoned Puerto Rico some time in 2006, according to the prosecutors. She chose to settle in Italy, a country whose laws have sometimes been used by fugitives to make their extradition difficult.
Ms Vazquez met a Florence taxi driver and they had twin daughters together before he read about her being wanted in Puerto Rico in the newspaper Corriere della Sera. The couple separated and the Italian, eventually, gained custody of the two girls.
In the meantime, according to information supplied to Abe Anhang by private detectives he hired in Italy, Ms Vazquez had approached the Florentine Jewish community. "She was embraced by the Jewish community as a widow with two children."
Mr Anhang Sr explains that the prenuptial agreement his son and Ms Vazquez signed included a pledge by her to study and take up the Jewish faith within two years.
According to US prosecutors, Ms Vazquez was helped by her brother, Charbel Vazquez Rijos, her sister, Marcia and her mother, who provided false paperwork to successfully dupe the Firenzebraica Jewish organisation in Florence into certifying in June 2012 that Aurea and her daughters were of Jewish descent, enabling her to move to Israel.
But, according to Mr Anhang Sr, Ms Vazquez did move around Europe, using "false names and several ID cards". His team of private detectives said they had traced her movements in Gibraltar, Spain, France and England.
According to prosecutors, in August 2012, Charbel Vazquez Rijos incorporated Glatt Kosher Traveller's Inc. in the Puerto Rico State Department, the plan apparently being to give his sister a means of earning money in Italy. But the travel company aimed at Jewish tourists was to prove Ms Vazquez's downfall.
The FBI and Spanish authorities set up a sting operation, inviting Ms Vazquez to Madrid to work as a guide to a fictitious tour group. She took the bait.
Arrested at Madrid's airport and imprisoned, Ms Vazquez began a new fight against extradition in Spain's courts.
Ms Vazquez became pregnant behind bars and had a baby. Spanish police sources have told the BBC that the father of the child was a small-time Italian crook, serving time in Spain for a drugs offence.
She was allowed to marry the father in jail, asking a Madrid judge not to extradite her as the mother of a Spanish citizen.
Finally, she was flown across the Atlantic in a private FBI jet in 2015, her month-old baby taken from her arms and sent into care after she landed in her native Puerto Rico.
Further legal delays and then Hurricane Maria led to several postponements of the trial, in which Ms Vazquez's brother, sister and the latter's partner will also face charges in the US federal court in San Juan.
Prosecutors have signed a sworn affidavit to Spanish authorities that they will not ask for the death sentence in the case, a condition of the final extradition agreement.
Mr Anhang Sr is optimistic that justice will finally be done for his son, but finds it ironic that his daughter-in-law's refusal to face trial may end up counting in her favour.
"Aurea is likely to get the lightest sentence of all the accused because she fled and waited to be extradited from a country which placed conditions on her transfer back to the United States to face justice.
"In essence, she will be getting rewarded with the same sentence as if she were caught and sentenced in Spain. At the same time her co-accused will get longer sentences, despite having much less involvement in the crime."
The BBC contacted Ms Vazquez's lawyer, Lydia Lizarribar, but she declined the invitation to comment on her client's defence strategy ahead of the trial.
decline the invitation toの誘いを辞退する