England captain Nat Sciver-Brunt has called for growth in The Hundred women’s competition to continue, and is keen that momentum is not lost with the arrival of private investment in the tournament.
From next summer, The Hundred will have private ownership across the eight franchises, including a 49% stake in Sciver-Brunt’s Trent Rockets purchased by Chelsea Football Club owner Todd Boehly.
That was one of four US-based investment groups, with the other four franchises bought, either in whole or in part, by owners of Indian Premier League teams.
However, only one of them – Mumbai Indians’ owners, the Ambani family, who have agreed to buy a 49% stake in Oval Invincibles – has a side in the Women’s Premier League in India.
“In the first five years we’ve done a lot of things right and the main part from the women’s side is to feel like you’re in equal measure, in equal opportunity, in equal everything really to the men’s side,” said Sciver-Brunt, speaking exclusively to BBC Sport.
“It’s the sense of belonging that that gives you as a women’s side, it’s transformed the way we do things and the cricket as well. So, hopefully we don’t lose that too much.”
Australia’s Bogong moth uses a stellar compass with help from Earth’s geomagnetic field to stay on course across about 620 miles to cool alpine caves, according to a new study.
The work shows that the moths can distinguish specific geographic directions at night using the starry sky alone.
Billions of bogong moths head for high country each spring, then reverse the journey in autumn after months of aestivation in cave walls. The feat is precise, seasonal, and inherited rather than learned.
Professor Eric Warrant of Lund University led the research with collaborators across Europe and Australia.
Moths navigate by stars
The team ran night flights in a rural, non-magnetic laboratory using a custom flight simulator that projected a natural star field above tethered moths, while removing magnetic cues so only the sky pattern could guide flight. They also ran outdoor tests under real skies to confirm the behavior in the field.
“When the starry sky was rotated 180 degrees, the moths also changed direction 180 degrees, but when the stars were distorted, their orientation disappeared. It was a real eureka moment to experience this in the experiments,” said David Dreyer, a researcher at Lund.
“Navigating by the stars is a capacity that only humans, often with the help of a sextant, and certain birds that migrate at night possess. Now we can establish that the Bogong moth is the first invertebrate so far known to master this feat,” said Warrant.
Why moths rely on stars for journeys
The night sky shifts across hours, yet the moths held their inherited course when the stars moved across the dome. That suggests they are extracting a stable cue from changing patterns.
Birds have long been shown to use star patterns, a result established in classic planetarium experiments with indigo buntings.
Moths now join the list of celestial navigators, but with a key twist, because they use the stars to aim for a specific geographic bearing, not just to keep a straight line.
Short range sky use is not unprecedented in insects. Dung beetles orient using the Milky Way to roll in a straight line away from competitors at the dung heap, which is a different task from long distance navigation to a fixed destination.
Moths switch to magnetic cues
On overcast nights, the moths still maintained their seasonally correct heading in field tests, a pattern consistent with a magnetic compass that steps in when the sky is hidden. That redundancy makes sense for nocturnal travel that can span many nights.
Earlier work in 2018 had already shown Bogong moths sense and use Earth’s magnetic field to steer, aligning magnetic and visual cues when they agree and losing orientation when the cues conflict.
The new results show that either cue alone can be sufficient, with stars taking the lead under clear skies.
How moths decode sky patterns
The study did not stop at behavior. The team recorded activity from visual neurons that responded when the projected star sky rotated, and those responses vanished when the stars were randomized, indicating tuning to natural celestial structure rather than generic motion.
Some cells peaked when the moth was oriented toward a common sky direction, which hints at how the brain encodes a stable heading from complex light patterns. The responses appeared in regions that interconnect sensory input with motor steering.
One navigation hub, the central complex, is known across insects as a circuit that computes heading and desired direction, and the new data are consistent with that role.
The pattern suggests a compact neural solution for fusing sky and magnetic information into a single steering command.
A plausible magnetic sensor
How an insect detects a weak magnetic field is still an open question. A leading hypothesis proposes a light dependent chemical reaction in cryptochrome proteins that forms magnetically sensitive radical pairs, which can change reaction yields depending on field orientation.
There is direct experimental support for cryptochrome-based magnetic sensing in another migratory insect, the monarch butterfly.
In this species, CRY1 mediates light-dependent inclination responses under Earth-strength fields and relies on both the antennae and the eyes as magnetosensory organs. Bogong moths may use a related mechanism, although that remains to be nailed down.
Future research directions
The findings raise the bar for what a small nervous system can do. A moth brain smaller than a grain of rice can extract compass information from dim, complex star fields and keep it calibrated with a magnetic fallback.
The approach is robust, portable, and cheap in energy. It also highlights why dark, clear skies still matter for nocturnal migrants that rely on faint celestial structure.
Two puzzles stand out. How do these moths decide they have reached the right mountain caves, and which local cues trigger the stop after the long haul?
There is also the question of calibration. The system likely needs a way to keep sky and magnetic compasses aligned over time, and to decide which to trust when the cues disagree.
The study is published in the journal Nature.
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A hybrid catalytic system can synthesize the amino acid alanine directly from used bioplastic, air, and water (Angew. Chem. Int. Ed. 2025, DOI: 10.1002/anie.202511466). The system could enable the recycling of waste plastic but also makes a valuable product from a cheap feedstock and without dangerous or expensive reagents.
One of the simpler amino acids, alanine is widely used across the food, pharmaceutical, and agricultural sectors. Currently the bulk of this global demand is met by microbial fermentation. Chemical syntheses typically employ toxic cyanide reagents and high-cost ammonia generated through the energy-intensive Haber–Bosch process.
But an interdisciplinary team led by Bocheng Qiu at Nanjing Agricultural University has overcome these limitations by combining thermochemical, plasma, and electrochemical processes to convert end-of-life polylactic acid (PLA) plastic into alanine.
First, a catalyst that the team developed oxidatively depolymerizes PLA, breaking it down into lactic acid monomers before oxidizing those to pyruvic acid. In parallel, a plasma discharge device activated molecular nitrogen in air to generate nitrogen dioxide, which was immediately dissolved in water to form nitric acid.
The team then combined these two unpurified feedstock streams into an electrochemical reactor, where a reductive process, mediated by a copper-bismuth alloy, give the final product, alanine. The reaction achieved an overall yield of 66% at a 100 g scale, and the robust sequence is capable of tolerating the typical impurities present in postconsumer waste such as cups, straws, and nonwoven fabrics, the team says.
For each step, the researchers completed a detailed mechanistic analysis and a thorough characterization of the respective catalysts. The group also performed lifecycle assessment and techno-economic analysis on the overall process, comparing the hybrid sequence against a thermocatalytic route employing ammonia as the nitrogen source. While the new synthesis showed increased profitability and a reduced carbon footprint, Eva Nichols, a catalysis and electrochemistry researcher at the University of British Columbia who was not involved in the work, believes it is unlikely to replace current methods of manufacture. The plasma step, which like the Haber–Bosch process also has a high energy demand, is potentially difficult to scale, particularly as the reaction produces toxic NO2 as an intermediate.
Nichols is incredibly positive about the work, although she says an important, and overlooked, consideration is that of the enantioselectivity of the entire process. “In terms of manufacturing an amino acid, it’s important to know, are we preserving a stereocenter, or is there racemization along the way? Depending on the input source of PLA plastic, it may be an enantiopure or a racemic mixture,” she says.
Despite this, Nichols says she is inspired by the creativity and thoroughness of Qiu’s approach. “I was very impressed by the breadth of this paper. It’s rare to see so much under one title,” she says. “The impressive combination of catalyst development, characterization of each system, the creative combination of the reactions, and just the sheer number of approaches that were used to interrogate all of those systems I thought was really quite exceptional.”
From January through June 2025, the Education Outreach Office at the University of Alaska Fairbanks Geophysical Institute (GI) continued its mission of bringing science to life by delivering the magic of its portable planetarium to communities across Alaska. This year, they reached over 1,807 students, educators, and participants through engaging, interactive astronomy experiences.
The portable planetarium is more than just a dome. It’s a getaway to curiosity, discovery and connection. Especially in Alaska’s long, cold winters, the dome offers a warm and welcoming space where learners of all ages can look up, wonder, and learn together. After experiencing the planetarium, feedback from students across the state reflects increased excitement about space, science, and their own place in the universe.
Each session begins with a warm introduction, a safety briefing, and a land acknowledgement. Participants experience constellations, planets, and space science concepts through dynamic storytelling and exciting visuals. The presentations connects ancient skywatching traditions with modern science, reminding students that long before the internet, the stars were a source of direction and knowledge. The presentation begins on Earth, exploring the State of Alaska, discussing the moon’s phases, and then, journeys outward to Mars, the last rocky planet, before reaching the gas giants. A standout moment of experience is the “Planet Walk” — an interactive journey from the Sun through the solar system. Learners leave with a new favorite word: ‘heliophysics,’ the science of the Sun and its influence on the solar system.
Knowledgeable presenters bring science to life with energy, empathy, and enthusiasm, engaging diverse audiences and making the event a memorable and impactful experience. Soumitra Sakhalkar, for example, is a GI graduate student researcher studying remote sensing of permafrost regions. Another presenter, Austin Smith, is a GI graduate student researcher in space physics. Several GI Communications staff members also contribute to the program’s success with logistics and technology support, crowd control and more.
This program is funded in part by the NASA Heliophysics Education Activation Team, which is part of NASA’s Science Activation Portfolio. Learn more about how Science Activation connects NASA science experts, content, and experiences with community leaders to do science in ways that activate minds and promote deeper understanding of our world and beyond: https://science.nasa.gov/learn/about-science-activation/. The remainder of the funding was generously supported by schools and organizations requesting the planetarium program.
In recent years, significant advancements have been achieved in the field of oncology through the development of immunotherapy. Various immune checkpoint inhibitors (ICIs) have been developed, which activate the immune system to restore normal function and kill tumor cells, offering more treatment options for patients.1 However, aberrant immune activation may attack normal tissues and organs, leading to immune-related adverse events (irAEs) and posing serious threats to patient health.2 Early diagnosis and appropriate management of irAEs are critical.
Checkpoint inhibitor-related pneumonitis (CIP) is the most prevalent corticosteroid-refractory irAE in lung cancer patients and is frequently associated with high mortality. Management typically requires combination immunosuppressive therapy. Compared to other corticosteroid-refractory irAEs, CIP exhibits lower response rates to immunosuppressants, thereby complicating therapeutic efforts.3 Currently, there is a paucity of prospective or comparative studies to establish optimal treatment strategies for corticosteroid-refractory CIP. Mycophenolate mofetil (MMF), an oral immunosuppressant, is commonly used in irAE cases such as immune hepatitis and myocarditis but is rarely reported for CIP, with no standardized dosing or monitoring protocols. This case report details the diagnosis and treatment of recurrent corticosteroid-refractory CIP, including MMF use and blood concentration monitor, and provides a literature review.
Case Presentation
Patient History and Baseline Status
A 59-year-old male patient with a medical history of gastric ulcer and type 2 diabetes presented with progressively worsening cough and hemoptysis over six years.
Clinical Course and Diagnostics
In February 2023, he was diagnosed with right lung squamous cell carcinoma (LUSC), classified as cT4N3M1a stage IV, with a tumor PD-L1 score (TPS) of 35%. From February 10 to March 8, 2023, he received first-line therapy comprising tislelizumab, albumin-bound paclitaxel (nab-paclitaxel) and carboplatin, achieving a partial response (PR) after two cycles. In March 2023, he developed grade 2 CIP, which was alleviated with methylprednisolone. In May 2023, he developed hypothyroidism secondary to immunotherapy, managed with levothyroxine. From May 16 to July 31, 2023, he continued chemotherapy (cycles 3–6) without immunotherapy. After six cycles, PET/CT showed sustained PR, though retroperitoneal lymph nodes exhibited progressive metabolic activity. Considering the patient’s high PD-L1 expression and previously manageable irAEs, immunotherapy was rechallenged. From August 31, 2023, to January 23, 2024, he received half-dose tislelizumab combined with nab-paclitaxel (cycles 1–6), maintaining PR. Subsequent maintenance therapy (cycles 7–16) with half-dose tislelizumab also maintained PR (Figure 1).
Figure 1 The history of the patient’s antitumor therapy.
Following the final treatment in November 2024, the patient presented exacerbation of symptoms, including a worsening cough with white sputum and orthopnea. On December 9, 2024, he was admitted with bilateral coarse crackles. Laboratory examination showed an elevated C-reactive protein level, normal procalcitonin levels, and hypoxemia with PaO2/FiO2 ratio (P/F ratio) of 260. Computed tomography (CT) scans demonstrated diffuse bilateral infiltrates affecting more than 50% lung tissue, consistent with grade 3 CIP. Tests and examinations excluded heart failure and the patient was unable to cooperate with tracheoscopy.
Stepwise Treatments
Initial treatment included methylprednisolone 60mg daily, moxifloxacin, and levothyroxine adjustment. By December 10, 2024, the patient’s condition had deteriorated further, with decrease of P/F ratio to 206. Sputum smear was negative for infection. Methylprednisolone dosage was increased to 120mg daily. Given the anticipated long-term use of corticosteroids, trimethoprim-sulfamethoxazole (TMP/SMZ 80 mg/400 mg) was prescribed at one tablet daily to prevent pneumocystic Carinii pneumonitis. On December 12, 2024, the patient’s cough intensified with the P/F ratio declined to 200, indicating a downward trend. This was considered to be corticosteroid-refractory CIP. Intravenous immunoglobulin (IVIG) was administered at a dosage of 400mg/kg (actual dose 25g) daily for 5 days, along with MMF capsules at 1g twice daily (bid) orally. The metabolite mycophenolic acid (MPA) was monitored (refer to detailed in discussion). Next generation sequencing of the patient’s sputum detected a low number of viral sequences without evidence of infection; therefore, antibiotics were discontinued. On December 13, 2024, the patient’s cough significantly relieved with P/F ratio increasing to 248. Consequently, the dosage of methylprednisolone was tapered to 80mg daily. By December 19, the P/F ratio had normalized to 352, and CT scans indicated significant resolution of inflammation. Corticosteroid were gradually tapered and completely discontinued on January 31, 2025. MMF was discontinued on January 6, 2025, due to self-administered cessation after 15 days.
Outcomes
On March 19, 2025, PET/CT revealed that CIP had nearly achieved complete remission, and antitumor therapy with nab-paclitaxel was restarted (Figure 2). The last follow-up was in June 2025. To date, the patient has completed 3 cycles of nab-paclitaxel treatment, and the disease has remained stable.
Figure 2 The history of recurrent corticosteroid-refractory CIP therapy.
Discussion
The Current Treatment of CIP
Severe CIP is a rare but explosive and fatal serious adverse event, accounting for 35% of the death events related to PD-1/PD-L1 inhibitors.4 In patients with non-small cell lung cancer undergoing monotherapy with PD-1/PD-L1 inhibitors, the incidence of pneumonitis is observed to be below 5%, with the incidence of grade 3 or higher pneumonitis is 0–1.7%. Notably, patients receiving PD-1 inhibitors monotherapy exhibit a higher incidence of immune-related pneumonitis compared to those receiving PD-L1 inhibitors.5 Furthermore, individuals with non-small cell lung cancer and renal cancer demonstrate greater susceptibility to immune-related pneumonitis than those with malignant melanoma, The incidence of pneumonitis in combination therapy is higher than that in monotherapy with PD-1/PD-L1 inhibitors.6 In this case, the patient experienced CIP on two occasions during the treatment of squamous cell lung cancer. The initial occurrence transpired approximately 46 days following the administration of tislelizumab, aligning with the typical timeline for the onset of immune adverse reactions. Based on the medical history, laboratory tests, examinations and existing literature, the second occurrence can be diagnosed as recurrent CIP. According to the “Guidelines for the Collection and Reporting of Individual Adverse Drug Reactions” and the Common Terminology Criteria for Adverse Events (CTCAE 5.0), the evaluation of the correlation between tislelizumab and CIP is “definite”, and the severity grade of this case of CIP is grade 3.7 Glucocorticoids are the primary treatment for CIP, and early intervention with glucocorticoids is a critical component of the comprehensive management of immune-related toxicity.8,9 Despite the administration of an adequate dosage of glucocorticoids, the patient’s CIP continued to progress after 48 hours, consistent with corticosteroid-refractory CIP.
For corticosteroid-refractory CIP, current guidelines and consensus recommend the selective addition of IVIG, tocilizumab, infliximab, mycophenolate mofetil, etc. for treatment.10–12 However, there remains a paucity of high-quality evidence to definitively establish the optimal therapeutic approach for corticosteroid-refractory CIP. Consequently, the treatment of corticosteroid-refractory CIP often relies on the experience and capabilities of the medical team. Nevertheless, retrospective studies and case reports can provide valuable insights and inform clinical practice.
Literature Review
In a retrospective study, 12 patients with corticosteroid-refractory CIP were analyzed. Of these, 7 patients received IVIG treatment, 2 patients received infliximab treatment, and 3 patients received the combined treatment of IVIG and infliximab. The study found that 8/12 (75%) patients succumbed to CIP or infectious complications, including 3 patients who received IVIG treatment and all 5 patients who received infliximab treatment.13 This study indicated significant variability in the clinical course and outcomes for patients with corticosteroid-refractory CIP. Notably, patients who received IVIG monotherapy exhibited improvement in oxygen requirements and the level of care, alongside a reduced mortality rate. Conversely, those treated with regimens containing infliximab experienced poorer outcomes. Additionally, a case report documented the use of IVIG for treating corticosteroid-refractory CIP, wherein the patient’s condition markedly improved within 72 hours post-administration of IVIG, and stabilized following ongoing glucocorticoid therapy.14 A single-center retrospective study showed that 34 patients with corticosteroid-refractory CIP (88.2% with lung cancer) were treated with tocilizumab, including 12 patients with grade 3–4 pneumonitis. The results showed that 79.4% of the patients (27/34) showed clinical improvement, and most patients only required a single dose or two doses of treatment.15 In addition, a series of case reports indicated that most patients with corticosteroid-refractory irAE could benefit from tocilizumab treatment.16 A retrospective study analyzed the efficacy of 26 patients with CIP treated with a combination of glucocorticoids and immunosuppressants. The results showed that when infliximab was used as the initial immunomodulator, the improvement rate for persistent pneumonitis was merely 20% (4 out of 20), with a 90-day survival rate of 35% (7 out of 20). In contrast, mycophenolate mofetil demonstrated a superior response, with an improvement rate of 83% (5 out of 6) and a 100% 90-day survival rate (6 out of 6).17 Furthermore, several retrospective studies have shown that the efficacy of infliximab in the treatment of CIP is limited, with some studies reporting negligible or even adverse outcomes, including the aforementioned two retrospective analyses.18 Therefore, there is some controversy about the application of infliximab in the treatment of CIP in the real world. In the treatment of steroid-refractory CIP, IVIG is recommended as a reasonable alternative to infliximab.19 We reviewed the reports of mycophenolate mofetil used in the treatment of CIP (Table 1), in which 2 cases achieved complete remission of CIP following combined therapy of mycophenolate mofetil and glucocorticoids. Additionally, a systematic review recommends the combined treatment of MMF and IVIG for corticosteroid-refractory CIP, by summarizing the existing evidence on steroid-refractory irAE and evaluating the guidelines related to irAE.20 Thus, IVIG appears to be a relatively effective and safe option for corticosteroid-refractory CIP, and the immunosuppressant combined on this basis needs to be carefully selected. Based on the available clinical data and the urgency of the patient’s condition, which could not wait for a long infection screening, and considering that the combined medication would bring more benefits, in this case, the treatment with intravenous human immunoglobulin combined with MMF capsules was initiated as soon as possible. After the treatment, the CIP achieved complete remission.
Table 1 Summary of Cases Treated with MMF for CIP
TDM for MMF
After oral administration, MMF is rapidly and completely metabolized into mycophenolic acid (MPA), which has immunosuppressive activity. However, significant inter-individual variability exists in the pharmacokinetics of MMF, and a certain correlation has been observed between drug exposure and both therapeutic efficacy and adverse reactions. Consequently, therapeutic drug monitoring (TDM) is deemed essential for MMF. Presently, most reports on the use of MMF for the treatment of irAE do not incorporate MMF monitoring, with only a single case describing the use of MMF in treating autoimmune hepatitis has attempted this.27 MMF is well-documented in the context of kidney transplantation, and its blood concentration reference range is also constructed based on the correlation between the combined medication for kidney transplantation outcomes. The application of MMF for irAE is relatively recent, and there remains a paucity of clinical research and data in this area. Therefore, only the treatment range for kidney transplantation can be referred to currently.
The Tmax of oral administration of mycophenolate mofetil range from 0.5 to 1 hour, with a half-life of 17.9 (±6.5) hours. TDM can be conducted once steady-state blood concentration is achieved by the 5th day. According to the relevant guidelines and consensus, the pharmacokinetic parameter used for the TDM of MMF is MPA-AUC, and the formula of the “three-point method” [30 minutes before drug administration (C0 trough concentration), 0.5 hour after drug administration (C0.5 peak concentration) and 2 hours after drug administration (C2)] is used for calculation.28,29 In this case, the patient received oral mycophenolate mofetil 1g twice daily on December 12, 2024, and blood samples were collected 0.5 hour before drug administration, 0.5 hour after drug administration and 2 hours after drug administration for laboratory testing on December 17, 2024. The test indicated that the C0 of MPA was 1.74 μg/mL, C0.5 was 8.75 μg/mL, and C2 was 2.31 μg/mL. The MPA-AUC was 47.6 mg·h/L when combined with tacrolimus, and 35.8 mg·h/L when combined with cyclosporine A. According to the recommended formula for calculation, the MPA-AUC has met the reference range in the guidelines of kidney transplantation (30–60 mg·h/L), and it can be considered that a satisfactory immunosuppressive effect can be achieved, but it should be noted that this range is based on the rejection reaction of kidney transplantation, and its reference value for irAE may be limited. From the drug safety standpoint, the MPA-AUC determined via the AUC method does not exceed the upper limit of the standard range, with a trough concentration of 1.74 μg/mL, which falls within the guideline-specified standard range for the trough concentration (1.0–3.5 μg/mL). Based on indirect evidence, the drug was deemed to be within a safe and effective range. However, establishing standardized TDM criteria for MMF in irAEs requires further clinical data.
Recommendations
This article presents a case involving a patient diagnosed with LUSC who experienced recurrent Grade 3 immune-related pneumonitis during treatment with tislelizumab, which was refractory to corticosteroids. Throughout the diagnostic and treatment process, comprehensive evaluation was conducted to assess the potential presence of concurrent infections, heart failure, or other complications. Ultimately, the CIP was alleviated with a regimen combining corticosteroids, IVIG, and MMF. A literature review was conducted to highlight the importance of early identification and timely, appropriate medication use for CIP. The use of immunosuppressive agents requires a balance between efficacy and adverse effects. Currently, there is insufficient evidence to recommend a specific immunosuppressive agent to be combined with corticosteroids, nor are there established standards for drug concentration monitoring. In this case, therapeutic drug monitoring was analyzed based on evidence from the clinical application of anti-rejection drugs in transplantation. Future research will require more epidemiological data and prospective studies to furnish additional evidence. Given the absence of standardized diagnostic and treatment for corticosteroid-refractory CIP, a preliminary diagnostic and treatment workflow is proposed based on this work and relevant guidelines (Figure 3).12,30–33 This study aims to enhance clinical awareness and management expertise regarding immune-related pneumonitis, thereby facilitating accurate clinical diagnosis and the development of rational treatment plans to optimize patient outcomes and minimize adverse effects.
Figure 3 Recommendation of the diagnosis and treatment process of corticosteroid-refractory CIP.
Conclusion
In conclusion, this case highlights the effective management of recurrent corticosteroid-refractory CIP with IVIG and MMF, emphasizing the importance of early diagnosis and tailored treatment strategies. Further investigation is warranted to establish standardized guideline for the management of corticosteroid-refractory CIP and to optimize therapeutic drug monitoring for immunosuppressive agents.
Ethics
Informed consent for publication of the patient’s deidentified case details was obtained from the patient before submission. This study was approved by the medical ethics committee of Peking University Third Hospital (IRB number: M20250470).
Funding
This report was supported by Beijing Natural Science Foundation (Grant No. 7254452), Beijing Science and Technology Innovation Medical Development Foundation (Grant No. KC2021-JX-0186-25) and 2022 Bethune Qiusuo Pharmaceutical Research Capacity Building Project.
Disclosure
The authors report no conflicts of interest in this work.
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Donald Trump may be persuaded that the Nobel peace prize he covets will “become a genuine possibility” if he succeeds in bullying Ukraine “into accepting the unacceptable” (Editorial, 11 August). But the idea that this deluded and most undiplomatic and unpeaceful of US presidents could ever join such recipients as Nelson Mandela, the Dalai Lama and Martin Luther King Jr is ludicrous.
Alfred Nobel intended the prize in the first instance for efforts for “the abolition or reduction of standing armies”. Under Trump, the already bloated Pentagon budget has skyrocketed; in June he celebrated the US army’s 250th birthday (as well as his own birthday) with a military parade, complete with tanks, missiles, and aeroplanes overhead; in February, he signed an executive order to dismantle the US Institute of Peace, resulting in the unlawful firing of its president and board members.
Nobel also mentioned in his will efforts to promote “fraternity between nations”. Trump’s Maga programme is at the expense of other nations, causing anger and anxiety in Canada, Denmark, Greenland, Iceland and elsewhere. He is complicit in the destruction of the Palestinian nation and the continuing devastation of Ukraine. The fact that he has been nominated is of little consequence (Hitler was too) and reflects poorly on the nominators. Dr Peter van den Dungen Visiting fellow, Norwegian Nobel Institute, 2000
Might the inclusion of Mar-a-Lago in the territories to be ceded to Russia get the Trump-Putin deal over the line (No deal, and no answers, after brief Trump-Putin talks on Ukraine in Alaska, 14 August)? Malcolm Rush Peterborough
Vaccines trigger a notably rapid response in the stromal cells of draining lymph nodes within the first hours after administration. Researchers at the University of Turku and the InFLAMES Flagship in Finland also discovered that the stromal alterations prime the lymph node landscape for the subsequent steps of vaccine-induced immune responses.
Lymph nodes are a key part of the human immune system, whose primary function is to combat infections. The effectiveness of vaccines is based on their ability to trigger events in lymph nodes that lead to the development of an immune response that protects the host against pathogens.
Researchers from Turku, Finland, observed that lymphatic endothelial cells and other stromal cells are the first cells in the lymph nodes to come into contact with vaccines. The vaccines induced several changes in stromal cells at the gene and protein levels within the first hours after vaccination, which in turn affected lymph node function.
The changes in the stromal cells were observed before the development of the protective immune response triggered by the vaccine. The researchers also discovered that different vaccines activate lymph node stromal cells in different ways.
The general perception is that specialized white blood cells begin to transport the active ingredients of a vaccine from the muscle to the lymph nodes approximately 12 hours after vaccination. Our new research results show that the vaccine-induced immune response of the lymph nodes begins much earlier, and the white blood cells bearing the antigens, or the active ingredients of the vaccine, actually arrive at an altered tissue environment that has already been primed by the vaccine. This priming supports the development of the immune response.”
Ruth Fair-Mäkelä, Postdoctoral Researcher of the Research Council of Finland, lead author of the study
“It was exciting to discover how different the responses induced by different types of vaccines were. One vaccine type, for example, had a direct effect on specific lymphatic endothelial cells. Another type of vaccine triggered a previously unknown phenomenon in which eosinophilic white blood cells accumulated in the draining lymph node,” says Fair-Mäkelä.
Fair-Mäkelä emphasised that even though the research group used COVID-19 vaccines as a model in their study, they did not examine their effectiveness or safety.
“Our aim was to understand the immunology of the early stages of the vaccine response, and indeed, we discovered completely new aspects of the role of stromal cells. In the future, we aim to investigate whether certain changes in stromal cells would be particularly beneficial for achieving the desired vaccine response,” notes Professor and InFLAMES group leader Marko Salmi, who led the study.
The study has been published in the esteemed journal Science Immunology. A total of 13 researchers participated in the study, which was funded by the Research Council of Finland, the InFLAMES Flagship, the Sigrid Jusélius Foundation, the Sakari Alhopuro Foundation, and the Instrumentarium Science Foundation.
Source:
Turun yliopisto (University of Turku)
Journal reference:
Fair-Mäkelä, R., et al. (2025) COVID-19 vaccine type controls stromal reprogramming in draining lymph nodes. Science Immunology. doi.org/10.1126/sciimmunol.adr6787.
Ahmad, 15, and his younger brother Sahil, 12, at the Torkham border between Pakistan and Afghanistan with their family, after returning from Pakistan.
Afghanistan’s fragile healthcare system is at breaking point under the strain of hundreds of thousands of Afghans deported from Iran and Pakistan over the past few months, many in urgent need of medical care.
This follows the decision by both Pakistan and Iran to repatriate Afghans, even those with refugee status in the case of Pakistan. Earlier this year, the UN High Commission for Refugees estimated that there were over 3,5 million Afghan refugees in Iran and 1,7 million in Pakistan.
Between January and 13 August, some 1.86 million Afghans have been returned from Iran and over 314,000 from Pakistan, bringing the total returns to over two million people over the past eight months alone.
Over eight million Afghans have fled their country over decades of war, but those in Iran and Pakistan are being deported to an uncertain future.
At Afghanistan’s Islam Qala border crossing with Iran, the human cost is stark: toddlers with sunken cheeks and dehydrated skin, elders bent over in coughing fits, heavily pregnant women staggering through the dusty camps, some giving birth amid chaos.
For the past many months, overwhelmed border Afghan health teams have confronted the same cycle of illnesses almost daily. Health workers say the illnesses surging through the camps are a predictable fallout of forced displacement colliding with an already overwhelmed healthcare system.
“Commonly reported health issues among returnees include trauma, malnutrition, infectious diseases such as acute watery diarrhoea and acute respiratory infections, and mental health problems,” according to the World Health Organization (WHO).
The sweltering camp for deportees reeks of over-flowing latrines and antiseptic, a grim reminder that these makeshift checkpoints have become the country’s first, and often only, line of defense against disease outbreaks.
In a torn tarpaulin’s thin shade, Zaher Qayumi, a father of five from Badghis Province, shields his children from the relentless sun. Just 10 days earlier, after five years in Iran, his nine-member family was abruptly expelled from Tehran. His children suffer from diarrhea and dizziness, their faces flushed with heatstroke.
“The situation here is terrible. Medicines, even for simple pain or diarrhea, are almost impossible to find,” Qayumi told Health Policy Watch.
“Iranian authorities are expelling everyone. The elderly and children suffer the most. People have no means and resources. Everyone is sick.”
It is extremely difficult and complicated to navigate for returnees to access what little public health services there are, and Qayumi’s words reveal the human face of the slow-motion public health emergency playing out across the desert border.
A WHO-supported disease surveillance support team conducts a health education session for returnees at Islam Qala border crossing.
Plea for immediate assistance
Stephanie Loose, UN Habitat head for Afghanistan, told a recent press briefing in Geneva that families are arriving after days of travel in blistering heat, enduring overcrowded tents and nights without enough food, water, or shelter.
“The real challenge is still ahead of us… people need access to basic services, to water, to sanitation, and overall, they do need livelihood opportunities for having a long term perspective and for also allowing them to, you know, lead their lives in dignity and to support their families,” said Loose.
Afghanistan’s humanitarian system is in free-fall. The country’s 2025 aid plan, valued at around $2.4 billion, is only 12% funded, according to the UN.
Aid agencies warn they are already cutting food, health, and shelter support, leaving millions at risk. UN officials are urging donors to act immediately, stressing that without swift contributions, lifesaving operations could collapse, plunging vulnerable communities into further desperation.
“At [Islam Qala’s] zero-point clinic, returning families arrive dehydrated, malnourished, and sick with respiratory and diarrheal diseases,” said Dr Noor Ahmad Mohammadi, head of the WHO-supported clinic. “We treat hundreds of children daily, most never vaccinated. Immediate action is critical to prevent rapid outbreaks.”
The clinic provides outpatient care and polio vaccinations, seeing roughly 200 patients and vaccinating 100 children under 10 each day. But with thousands crossing daily, their modest resources are overwhelmed.
UNHCR has expressed concern that many Afghans, regardless of status, “face serious protection risks in Afghanistan due to the current human rights situation, especially women and girls”.
Forgotten crisis
Afghanistan’s health system, hollowed out by decades of conflict, chronic underfunding, and the exodus of medical professionals following the Taliban’s rise to power in 2021, was already on the brink of collapse before the deportations began.
“Afghanistan is facing a deepening humanitarian crisis fuelled by a deteriorating human rights situation, prolonged economic hardship, recurring natural disasters and limited access to critical services. The large-scale returns of over 2.1 million Afghans from Iran and Pakistan in 2025 have further exacerbated the situation,” said UNHCR in a statement.
Aid agencies warn that as many as three million Afghans could be pushed back by the year’s end, raising the risk of a preventable public health disaster without urgent scale-up of clean water, vaccinations, and emergency care.
“The crisis is forgotten by much of the world,” said Nicole van Batenburg of the International Federation of Red Cross and Red Crescent Societies in a statement. “Local health systems are simply not equipped to cope.”
Many families were given mere hours to leave homes in Iran or Pakistan, abandoning belongings, medication, and any sense of security. Children arrive with fevers, diarrhea, scabies, and trauma; parents carry the weight of uprooted lives.
By spring 2025, more than 200 health facilities across Afghanistan had closed or suspended services due to lack of funds, the WHO reports.
Dr Edwin Ceniza Salvador, WHO’s Afghanistan representative, warns that 80% of supported health services could shut down without fresh funding.
“Mothers are unable to give birth safely, children missing lifesaving vaccines, and more preventable deaths every day,” he said.
In a corner of the border camp, Zohra*, a 28‑year‑old pregnant woman, lay on a thin mat, clutching her stomach. She was seven months pregnant when her six-member family was forcibly expelled from Mashhad in Iran.
“We were told to leave within hours. I couldn’t procure the medicines I needed even before this ultimatum as I feared arrest going to the hospitals,” she said in a faint voice. “The journey was long and hot. I thought I would lose my baby on the road.”
By the time she reached the Afghan border, Zohra was severely dehydrated and showing signs of early labour. Border clinic staff managed to stabilise her, but they warned that complications could turn deadly if she cannot access a proper hospital in time.
“I wish my daughter comes to this world alive and healthy, but I worry what kind of place my children would live and grow in Afghanistan”, Zohra said.
An earlier wave of deportations from Pakistan has already strained the Afghan healthcare system. Since late 2023, tens of thousands of Afghans, many of whom had lived in Pakistan for decades, have been forced to cross back to Afghanistan with little more than what they could carry.
The UN estimates that in this year alone, at least 314,000 Afghans had been returned from Pakistan by the end of July, often arriving with untreated chronic conditions, respiratory infections, and severe malnutrition, while vaccination records are frequently missing.
No medicine or food
Halima Bibi, an elderly diabetic woman, had lived as a refugee in Pakistan for years before she was expelled from the outskirts of Islamabad with her son’s 10-member family. Her health situation embodies the health crisis in Afghanistan.
“My feet are swollen, and I can barely stand,” she said. “I haven’t had my medicine or proper food for days. We had to wait anxiously for days to get an extension for our stay in Pakistan, but they forced us to leave without any consideration or time to prepare.”
Across Afghanistan’s border, in provinces like Nangarhar where Bibi lives, clinics and hospitals are swamped, lacking the resources to meet the urgent needs as well as management of chronic diseases like diabetes.
Halima is fearful that insulin medicine would not be easily available for her in Afghanistan and this will cause her serious health complications.
The Taliban’s deputy minister for refugees and repatriation, Abdul Rahman Rashid, has publicly rebuked host countries for the mass expulsions, describing the removal of Afghans as a “serious violation of international norms, humanitarian principles, and Islamic values.”
“The scale and manner in which Afghan refugees have been forced to return to their homeland is something Afghanistan has never before experienced in its history,” Rashid told a press conference in Kabul last month.
Back at Islam Qala border crossing, the transit clinic operates 24/7 where the returnees arrive with health conditions that are manageable in a well-resourced hospital, but often life-threatening here. Women and girls face particular concerns over movement restrictions and access to healthcare.
As summer heat intensifies and thousands continue to arrive daily, aid workers warn the window to prevent a full-blown humanitarian and public health catastrophe is closing fast.
Image Credits: UNHCR/ Oxygen Empire Media Production, UNHCR, WHO Afghanistan.
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