TED@IBM
Joshua Smith: New nanotech to detect cancer early
約書亞·史密斯: 嶄新的早期癌症檢測奈米科技
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倘若家家戶戶都有早期預警癌症的系統會如何呢？約書亞·史密斯研發一種奈米生技的癌症警報系統，能夠自動快篩「胞外染色體」這些生物標記。他在這個前瞻的演講裡分享革新的癌症偵測法，最終能挽救許多性命。
Joshua Smith - Cancer fighter
Motivated by his wife's bout with cancer, IBM's Joshua Smith applies his engineering expertise to early diagnosis. Full bio
Motivated by his wife's bout with cancer, IBM's Joshua Smith applies his engineering expertise to early diagnosis. Full bio
Double-click the English transcript below to play the video.
00:16
"You have cancer."
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「你得了癌症。」
00:20
Sadly, about 40 percent of us will hear
those three words within our lifetime,
those three words within our lifetime,
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很不幸，約有 40% 的人
會在活著時聽到這幾個字，
會在活著時聽到這幾個字，
00:25
and half will not survive.
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其中半數終將不治。
00:28
This means that two out of five
of your closest friends and relatives
of your closest friends and relatives
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意味著我們每五個親友當中
00:32
will be diagnosed
with some form of cancer,
with some form of cancer,
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有兩個會被診斷出罹患某種癌症，
00:35
and one will die.
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而一個會病故。
00:39
Beyond the physical hardships,
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除了身心受苦，
00:40
roughly one-third
of cancer survivors here in the US
of cancer survivors here in the US
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大約三分之一的美國癌症倖存者
00:43
will go into debt from treatment.
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會因為醫療而負債累累；
00:45
And they're at least two and a half times
more likely to declare bankruptcy
more likely to declare bankruptcy
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他們破產的機率
至少是未罹癌者的 2.5 倍。
00:49
than those without cancer.
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00:51
This disease is pervasive.
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癌症無所不在，
00:54
It's emotionally draining
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它損耗人的情感，
00:55
and, for many,
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使許多人
00:56
financially destructive.
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散盡家財。
00:59
But a cancer diagnosis
doesn't have to be a death sentence.
doesn't have to be a death sentence.
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但是被診斷出罹癌不等於被宣判死刑。
01:03
Finding cancer early,
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及早發現
01:05
closer its genesis,
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和貼近找出它的成因，
01:07
is one of the critical factors
to improving treatment options,
to improving treatment options,
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對於提高存活率、
01:10
reducing its emotional impact
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減低情緒影響，
01:12
and minimizing financial burdens.
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和降低財務負擔至關重要。
01:15
Most importantly,
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最關鍵的是要儘早發現癌症，
01:16
finding cancer early --
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01:18
which is one of the primary
aims of my research --
aims of my research --
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這也是我主要的研究目標之一，
01:21
greatly enhances your odds of survival.
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能夠大大提高存活率。
01:24
If we just look at the case
of breast cancer for example,
of breast cancer for example,
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舉乳癌為例，
01:26
we find that those who are diagnosed
and treated at stage one
and treated at stage one
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在第一期就診斷且治療的患者
01:30
have a five-year survival rate
of nearly 100 percent --
of nearly 100 percent --
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五年的存活率幾近百分之百，
01:34
odds that decrease to just 22 percent
if treated at stage four.
if treated at stage four.
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如果到第四期才治療就只剩 22%。
01:40
And similar trends are found
for colorectal and ovarian cancer.
for colorectal and ovarian cancer.
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大腸直腸癌和卵巢癌的情況類似。
01:46
Now, we're all aware
that an early diagnosis that is accurate
that an early diagnosis that is accurate
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大家都知道，早期的準確診斷
01:51
is critical for survival.
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是存活與否的關鍵。
01:55
The problem is that many
cancer diagnostic tools are invasive,
cancer diagnostic tools are invasive,
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問題是很多癌症篩檢具有侵入性，
01:59
costly,
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價格昂貴，
02:00
often inaccurate
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常常不準確，
02:01
and they can take an agonizing
amount of time to get the results back.
amount of time to get the results back.
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並且等待結果既焦慮又曠日費時。
02:06
Still worse, when it comes
to some forms of cancer,
to some forms of cancer,
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更糟的是若干癌症，
02:08
such as ovarian,
liver or pancreatic cancer,
liver or pancreatic cancer,
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例如卵巢癌、肝癌、胰臟癌，
02:13
good screening methods simply don't exist,
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根本沒有好的檢驗方式，
02:16
meaning that often people wait
until physical symptoms surface,
until physical symptoms surface,
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意味著等到出現症狀時
02:20
which are themselves already
indicators of late-stage progression.
indicators of late-stage progression.
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已經到了癌症擴散的晚期。
02:25
Like a tornado strike in an area
without an early warning system,
without an early warning system,
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就好像在沒有龍捲風預警的地區
02:29
there is no alarm to warn,
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沒有警報，
02:31
for the danger is already at your doorstep
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一旦龍捲風到了家門口，
02:34
when your odds of survival
are greatly reduced.
are greatly reduced.
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存活的機會就大大減少了。
02:39
Having the convenience and accessibility
of regular screening options
of regular screening options
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方便、易取得、
02:43
that are affordable, noninvasive
and could provide results much sooner,
and could provide results much sooner,
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便宜、非侵入性
和快篩的定期檢驗方式
02:49
would provide us with a formidable
weapon in the fight against cancer.
weapon in the fight against cancer.
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將會是我們對抗癌症的強大利器。
02:54
An early warning would allow us
to get out ahead of the disease
to get out ahead of the disease
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及早發現讓我們能搶得治療先機，
02:57
instead of merely
following in its relentless wake.
following in its relentless wake.
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而非只苦追在它殘酷無情的腳步後面。
03:00
And this is exactly what I've been doing.
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這正是我的工作。
03:02
For the past three years,
I've been developing technologies
I've been developing technologies
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過去三年來，
我一直在研發能夠幫助臨床醫生
03:05
that could ultimately aid clinicians
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03:07
with rapid, early-stage
cancer diagnostics.
cancer diagnostics.
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快速、早期診斷癌症的科技。
03:10
And I've been fueled
by a deep scientific curiosity,
by a deep scientific curiosity,
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強烈的科學好奇心與熱情
推動我要改變那些癌症的統計數據。
03:14
and a passion to change these statistics.
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03:18
Last year however,
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去年
03:20
this fight became much more personal
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我的妻子被診斷出罹患乳癌，
使這努力成了與自身息息相關的戰鬥，
03:24
when my wife was diagnosed
with breast cancer.
with breast cancer.
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03:27
It was an experience that added a strong
and unexpected emotional dimension
and unexpected emotional dimension
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參雜了我始料未及的情感層面。
03:32
to these efforts.
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我親身體驗到
03:35
I know firsthand how life-altering
treatment can be,
treatment can be,
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治療對生活所造成的巨大衝擊，
十分清楚它帶來的精神浩劫，
03:39
and I'm keenly aware
of the emotional havoc
of the emotional havoc
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03:42
that cancer can wreak on a family,
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癌症可能會毀滅我們的家庭，
03:44
which in our case
included our two young daughters.
included our two young daughters.
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包括我們兩個年幼的女兒。
經由定期乳房攝影檢查及早發現，
03:48
Because we found it early
during a routine mammogram,
during a routine mammogram,
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我們得以專注治療仍限於局部的腫瘤，
03:51
we were able to focus
primarily on treatment options
primarily on treatment options
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03:55
for the localized tumor,
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03:56
reaffirming to me
how important an early diagnosis is.
how important an early diagnosis is.
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使得我再次確認早期診斷極其重要。
04:02
Unlike other forms of cancer,
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不同於其他的癌症，
乳房攝影檢查能有效偵測早期乳癌。
04:05
mammograms do offer an early-stage
screening option for breast cancer.
screening option for breast cancer.
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儘管如此，仍有人沒定期做檢查，
04:09
Still, not everyone has this done,
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04:11
or they may develop breast cancer
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也有人未達建議該接受乳房攝影
檢查的年齡之前就已罹患乳癌。
檢查的年齡之前就已罹患乳癌。
04:12
before the middle age recommendation
for having a mammogram.
for having a mammogram.
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因此，即便已有篩檢方式的癌症
仍有很大的改善空間。
仍有很大的改善空間。
04:17
So, there's still
a lot of room for improvement,
a lot of room for improvement,
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04:19
even for cancers
that do have screening options,
that do have screening options,
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04:22
and, of course, considerable benefits
for those that don't.
for those that don't.
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而那些尚未有篩檢法的癌症
更將會大大受益。
更將會大大受益。
04:25
A key challenge then
for cancer researchers
for cancer researchers
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癌症研究者的關鍵挑戰在於
04:28
is to develop methods
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開發出一種用於定期體檢，
04:29
that make regular screening
for many types of cancers
for many types of cancers
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能夠更容易查出多種癌症的方法。
04:33
much more accessible.
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04:35
Imagine a scenario
where during your regular checkup,
where during your regular checkup,
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想像這情境：
醫生在定期體檢時能採取
簡單、非侵入性的尿液樣本
簡單、非侵入性的尿液樣本
04:39
your doctor can take
a simple, noninvasive urine sample,
a simple, noninvasive urine sample,
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或是其他的液狀活檢體，
04:42
or other liquid biopsy,
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04:44
and present you with the results
before you even leave the doctor's office.
before you even leave the doctor's office.
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在你離開診所之前就告訴你結果。
這樣的科技能夠大量減少
04:48
Such a technology could
dramatically reduce the number of people
dramatically reduce the number of people
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早期癌症篩檢所漏掉的人數。
04:52
who slip through the net
of an early-stage cancer diagnosis.
of an early-stage cancer diagnosis.
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我的工程與生化研究團隊面對這挑戰，
04:56
My research team
of engineers and biochemists
of engineers and biochemists
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04:59
is working on exactly this challenge.
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正試圖找出一種能在人們仍健康時
05:02
We're working on ways to frequently
activate an early-stage cancer alarm
activate an early-stage cancer alarm
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就會觸發應該去做定期體檢的警示，
05:07
by enabling regular screenings
that would start when a person is healthy
that would start when a person is healthy
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05:11
so that action could be taken
to stop cancer the moment it emerges,
to stop cancer the moment it emerges,
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一旦出現癌症徵兆，馬上採取行動，
不讓它有機會擴展到中、後期。
05:16
and before it can progress
beyond its infancy.
beyond its infancy.
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此處的殺手鐧被稱為「胞外染色體」，
05:20
The silver bullet in this case
are tiny vesicles,
are tiny vesicles,
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05:23
little escape pods regularly shed
by cells called exosomes.
by cells called exosomes.
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是細胞經常脫落的小小逃生艙。
05:28
Exosomes are important biomarkers
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胞外染色體
是能在癌症早期預警的重要生物標記。
05:31
that provide an early-warning system
for the development of cancer.
for the development of cancer.
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這些標記大量而廣泛存在體液裡，
05:35
And because they're abundantly present
in just about every bodily fluid,
in just about every bodily fluid,
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05:39
including blood, urine and saliva,
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包括血液、尿液和唾液中，
05:41
they're extremely attractive
for noninvasive liquid biopsies.
for noninvasive liquid biopsies.
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不具侵入性，極具液體活檢的優勢。
05:47
There's just one problem.
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但這裡仍然有個問題，
05:48
An automated system for rapidly sorting
these important biomarkers
these important biomarkers
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能夠自動快篩這些生物標記的機制
05:52
is not currently available.
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目前並不存在。
05:55
We've created a technology
that we call nano-DLD
that we call nano-DLD
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我們建立了稱作「奈米 DLD」的科技
05:59
that is capable of precisely this:
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能夠精準做到
06:01
automated exosome isolation
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自動分離出胞外染色體
06:04
to aid rapid cancer diagnostics.
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以快速癌症篩檢。
06:08
Exosomes are the newest
early-warning weapon, if you will,
early-warning weapon, if you will,
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胞外染色體是出現在液體活檢陣線的
06:11
to emerge on the liquid biopsy front.
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最新早期預警利器。
06:13
And they're really, really small.
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它們非常微小，
06:16
They measure just 30 to 150
nanometers in diameter.
nanometers in diameter.
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直徑僅有 30 到 150 奈米，
06:20
This is so tiny
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小到
06:21
that you could fit about a million
of them into a single red blood cell.
of them into a single red blood cell.
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一粒紅血球的體積裡能裝下一百萬個，
06:25
That's roughly the difference
between a golf ball
between a golf ball
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比例相當於一顆高爾夫球
06:28
and a fine grain piece of sand.
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對應於一粒沙子。
06:30
Once thought to be little bins
for unwanted cellular waste,
for unwanted cellular waste,
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它雖曾被認為是細胞廢物的垃圾桶，
06:34
it has been found
that cells actually communicate
that cells actually communicate
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後來卻發現，事實上細胞經由
06:37
by producing and absorbing these exosomes
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產生和吸收胞外染色體來互相溝通，
06:40
which contain surface receptors,
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因為它們具有表面接收器、蛋白質
06:43
proteins and other genetic material
collected from their cell of origin.
collected from their cell of origin.
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以及母細胞所給予的基因。
06:48
When absorbed by a neighboring cell,
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一旦被臨近的細胞所吸收，
06:51
exosomes release their contents
into the receiving cell,
into the receiving cell,
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胞外染色體就會釋放內含的物質，
06:55
and can set in motion
fundamental changes in gene expression --
fundamental changes in gene expression --
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大幅改變接收細胞的基因表現。
06:58
some good,
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有些是好的改變；
06:59
and this is where cancer comes in,
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但在癌症的情況下
07:01
some bad.
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則是不好的改變。
07:02
Because they are clothed
in the material of the mother cell,
in the material of the mother cell,
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因為它們被母細胞的物質包覆著，
07:06
and contain a sample of its environment,
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裡頭含有環境的樣本，
07:08
they provide a genetic snapshot
of that cell's health and its origin.
of that cell's health and its origin.
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可以提供來源細胞的健康情況。
07:15
All of these qualities
make exosomes invaluable messengers
make exosomes invaluable messengers
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胞外染色體具有這些無價的特質
07:18
that potentially allow physicians
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使得醫生能從細胞層面
07:20
to eavesdrop on your health
at the cellular level.
at the cellular level.
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監測你的健康水平。
07:24
To catch cancer early, however,
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但想要儘早發現癌症
07:25
you have to frequently
intercept these messages
intercept these messages
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就必須頻繁截取這些訊息，
07:28
to determine when cancer-causing
troublemakers within your body
troublemakers within your body
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看體內潛伏的鬧事份子
07:32
decide to start staging a coup,
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是不是要滋事了。
07:34
which is why regular
screening is so critical
screening is so critical
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這就是為什麼定期檢查非常重要，
07:37
and why we're developing
technologies to make this possible.
technologies to make this possible.
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以及我們為什麼要發展這科技。
07:41
While the first exosome-based diagnostics
emerged on the market just this year,
emerged on the market just this year,
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儘管今年市場上出現了
首宗胞外染色體檢驗機制，
首宗胞外染色體檢驗機制，
07:46
they are not yet part
of mainstream healthcare options.
of mainstream healthcare options.
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它們還不是主流的篩檢選項。
07:51
In addition to their recent emergence,
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除了上市的時間很短，
07:53
another factor that's limiting
their widespread adoption
their widespread adoption
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另一個影響普及的因素
07:56
is that currently, no automated
exosome isolation system exists
exosome isolation system exists
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是目前尚無法自動分離出胞外染色體，
08:00
to make regular screening
economically accessible.
economically accessible.
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所以用於定期體檢仍不夠便宜。
08:04
The current gold standard
for exosome isolation
for exosome isolation
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當下隔絕胞外染色體的標準做法，
08:07
includes ultracentrifugation,
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包括超速離心法，
08:09
a process requiring
expensive laboratory equipment,
expensive laboratory equipment,
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必須使用昂貴的實驗器材，
08:12
a trained lab tech
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由專業培訓過的技師操作，
08:14
and about 30 hours of time
to process a sample.
to process a sample.
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耗費三十小時來處理一份樣本。
我們想出另一種方法，
08:18
We've come up with a different approach
for achieving automated exosome isolation
for achieving automated exosome isolation
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從尿液之類的液體樣本
自動分離出胞外染色體。
08:23
from a sample such as urine.
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08:25
We use a chip-based, continuous flow
separation technique
separation technique
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我們用基於晶片的持續流動分離技術，
08:29
called deterministic lateral displacement.
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這方法稱為「確定性側向位移」。
08:32
And we have done with it
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藉由過去五十年來半導體產業
08:34
what the semiconductor industry has done
so successfully for the past 50 years.
so successfully for the past 50 years.
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非常成功的晶片微縮技術，
08:38
We shrunk the dimensions
of this technology
of this technology
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我們把這技術
08:40
from the micron scale
to the true nanoscale.
to the true nanoscale.
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從微米縮小到了真正的奈米等級。
08:44
So how does it work?
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原理是什麼呢？
08:46
In a nutshell,
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簡單來說，
08:47
a set of tiny pillars
separated by nanoscopic gaps
separated by nanoscopic gaps
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把許多有奈米級間隙的細小柱子
排成能讓液體細細分流的形式，
08:51
are arranged in such a way
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08:52
that the system divides
the fluid into streamlines,
the fluid into streamlines,
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08:55
with the larger cancer-related
nanoparticles being separated
nanoparticles being separated
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較大的癌症奈米粒子會改道，
08:59
through a process of redirection
from the smaller, healthier ones,
from the smaller, healthier ones,
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與較小的健康粒子分流；
09:03
which can in contrast
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另一方面，
體積較小的健康粒子
會沿著之字形的方向移動。
會沿著之字形的方向移動。
09:04
move around the pillars
in a zigzag-type motion
in a zigzag-type motion
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09:07
in the direction of fluid flow.
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09:10
The net result is a complete separation
of these two particle populations.
of these two particle populations.
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結果大小兩種粒子被完全分開了。
09:15
You can visualize this separation process
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可以把分離的過程
觀想成用有高度限制的穿山隧道
09:19
similar to traffic on a highway
that separates into two roads,
that separates into two roads,
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把車流一分為二：
09:23
with one road going into
a low-clearance tunnel under a mountain,
a low-clearance tunnel under a mountain,
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一條進隧道，另一條繞山而過。
09:26
and the other road going around it.
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09:28
Here, smaller cars
can go through the tunnel
can go through the tunnel
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像這樣，小車可以進入隧道，
09:31
while larger trucks,
carrying potentially hazardous material,
carrying potentially hazardous material,
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而載有危險物品的大卡車
09:34
are forced to take the detour route.
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只能繞路。
09:37
Traffic is effectively separated
by size and contents
by size and contents
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由車輛的大小和載物的種類引導，
09:41
without impeding its flow.
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不會阻礙車流。
09:43
And this is exactly how our system works
on a much, much smaller scale.
on a much, much smaller scale.
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我們建置的工作原理相同，
只是規模遠小得多。
09:49
The idea here is that
the separation process for screening
the separation process for screening
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用分離篩檢的理念來分析
簡易取得的尿液、血液或唾液樣本，
09:53
could be as simple as processing
a sample of urine, blood or saliva,
a sample of urine, blood or saliva,
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09:57
which is a near-term possibility
within the next few years.
within the next few years.
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近幾年內就可實行。
10:00
Ultimately, it could be used
to isolate and detect target exosomes
to isolate and detect target exosomes
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最終，這方法能分離和偵測出
10:06
associated with
a particular type of cancer,
a particular type of cancer,
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與特定癌症相關的胞外染色體，
10:09
sensing and reporting
their presence within minutes.
their presence within minutes.
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而且自偵測至結果僅需數分鐘，
10:12
This would make rapid diagnostics
virtually painless.
virtually painless.
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使得篩檢的過程快速且無痛。
10:16
Broadly speaking,
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廣泛說，
10:18
the ability to separate
and enrich biomarkers
and enrich biomarkers
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有了奈米級精準的自動化分離機制
10:20
with nanoscale precision
in an automated way,
in an automated way,
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與濃縮的生物標記，
10:24
opens the door to better understanding
diseases such as cancer,
diseases such as cancer,
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使我們更能了解癌症等疾病；
10:27
with applications ranging
from sample preparation to diagnostics,
from sample preparation to diagnostics,
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它的應用廣泛，從準備樣品、診斷，
10:31
and from drug resistance
monitoring to therapeutics.
monitoring to therapeutics.
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至觀察抗藥性和治療都能做。
10:35
Even before my wife's bout with cancer,
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即使在我的妻子罹癌之前，
10:37
it was a dream of mine to facilitate
the automation of this process --
the automation of this process --
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我已經夢想要自動化檢驗的過程，
10:41
to make regular screening more accessible,
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要使定期檢查更容易，
10:44
similar to the way Henry Ford
made the automobile accessible
made the automobile accessible
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就像亨利·福特自動化汽車的生產線，
10:47
to the general population
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使得普羅大眾買得起汽車那樣。
10:49
through development of the assembly line.
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10:51
Automation is the key to accessibility.
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自動化是普及的關鍵。
10:56
And in the spirit of the Hoover dream,
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就像胡佛選總統的逐夢精神口號：
10:58
"a chicken in every pot
and a car in every garage,"
and a car in every garage,"
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「每只鍋裡有雞肉，每間車庫有輛車。」
11:01
we're developing a technology
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我們開發這技術
11:02
that could ultimately place
an early-warning cancer detection system
an early-warning cancer detection system
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為的是把早期的癌症預警系統
最終普及於每個家庭。
11:06
in every home.
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11:08
This would allow
every man, woman and child
every man, woman and child
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讓每個男人、女人和小孩
11:10
the opportunity to be regularly tested
while they're still healthy,
while they're still healthy,
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都能夠在仍然健康時就定期做檢查，
11:14
catching cancer when it first emerges.
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在初發的早期就偵測到癌症。
11:17
It is my hope and dream
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我希望，我夢想
11:18
to help people around the world
avoid the high costs --
avoid the high costs --
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要幫助世人
避掉癌症患者所面對的昂貴開銷，
11:22
physical, financial and emotional --
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免去身體、財務和精神層面的艱辛，
11:25
faced by today's cancer patients,
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11:27
hardships that I'm well acquainted with.
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那是我再熟悉也不過的艱辛。
11:31
I'm also happy to report that because
we caught my wife's cancer early,
we caught my wife's cancer early,
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我也開心地告訴大家，
由於發現得早，
我的妻子治癌成功，
11:35
her treatment was successful,
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11:37
and she is now, thankfully, cancer-free.
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謝天謝地，現在她已肅清癌細胞。
11:39
(Applause)
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（掌聲）
11:48
It is an outcome that I would like to see
for everyone with a cancer diagnosis.
for everyone with a cancer diagnosis.
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我希望每位罹癌者都能被治癒。
11:53
With the work that my team
has already done
has already done
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我團隊開發的奈米生物標記分離法
11:55
on separation of nanoscale biomarkers
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能快速、早期偵測出癌症。
11:58
for rapid, early-stage cancer diagnostics,
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12:01
I am optimistic
that within the next decade,
that within the next decade,
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我樂觀看待在未來十年內，
12:03
this type of technology will be available,
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這技術會被用來
12:06
helping protect our friends,
our family and future generations.
our family and future generations.
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保護我們的朋友、家人和子孫後代。
12:10
Even if we are so unlucky
as to be diagnosed with cancer,
as to be diagnosed with cancer,
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即便我們不幸被診斷出癌症，
12:14
that early-stage alarm
will provide a strong beacon of hope.
will provide a strong beacon of hope.
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早期警示將會提供更大的治癒希望。
12:18
Thank you.
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謝謝大家。
12:19
(Applause)
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（掌聲）
ABOUT THE SPEAKER
Joshua Smith - Cancer fighterMotivated by his wife's bout with cancer, IBM's Joshua Smith applies his engineering expertise to early diagnosis.
Why you should listen
As a research scientist and technical team lead for IBM's Nanobiotechnology Program, Dr. Joshua Smith researches innovative healthcare technologies at the intersection of engineering and biology to better understand disease progression.
Smith's team recently developed a chip-based solution that can rapidly isolate biomarkers as small as 20 nanometers to help identify cancer development even before symptoms occur. He is a sought-after speaker on the subject of lab-on-a-chip applications for healthcare and his work has been highlighted by Forbes, CNN Money, IEEE Spectrum and Pharma Technology Focus, among other media outlets. As a Research Staff Member and IBM Master Inventor, Smith has co-authored more than a dozen peer-reviewed scientific publications and is a co-inventor of more than 30 issued patents.
Currently, Smith is focusing on the development of a suite of core capabilities to manipulate, separate and detect individual macromolecules, providing a technological backbone for automation in sample preparation, diagnostics and therapeutics. When not with his colleagues in the lab, Smith enjoys teaching tomorrow's researchers and engineers at Columbia University.
Joshua Smith | Speaker | TED.com