Lung cancer is the most common cancer and the leading cause of cancer death worldwide, with an estimated 2.1 million new cases and 1.8 million deaths in 2018. Although small cell lung cancer (SCLC) is the most aggressive type of lung cancer, it shows high response rates to chemotherapy in early lines of therapy. Unfortunately, it is associated with rapid recurrence and relatively poor prognosis. Over the last few years, considerable progress has been made in cancer immunotherapy. One of the most promising ways to activate therapeutic antitumor immunity is via blockade of immune checkpoints, such as cytotoxic T lymphocyte-associated protein-4 (CTLA-4) and programmed cell death protein-1/programmed cell death ligand-1 (PD-1/PD-L1). Immune checkpoint inhibitors show promise as SCLC therapeutics. The overall expectation for immuno-oncology is high, and the outcomes of trials will hopefully reveal a variety of treatment options for SCLC patients. In this review, we discuss the discovery of new immune inhibitory and stimulatory pathways and rational combination strategies to explain the role of immunotherapy in SCLC and its future opportunities and challenges.

Introduction: Immune-based and antibody-drug conjugate therapies have shown promise in the treatment of patients with small cell lung cancer (SCLC). However, better predictive biomarkers are needed for selection of the appropriate SCLC patients for these advanced therapies and also for evaluation of the efficacy of these treatments. Objective: The aim of this study was to examine the expression of delta-like protein 3 (DLL3), cytotoxic T lymphocyte-associated protein 4 (CTLA-4), and mesothelin (MSTN) in patients with SCLC and compare them with those patients’ clinical characteristics. Methods: Immunohistochemical analyses of DLL3, CTLA-4 and MSTN expression were performed in 38 samples from patients with SCLC. Results: We found that positive expression in patients of the biomarkers was as follows: for DLL3, 100% (38/38), for CTLA-4, 89.5% (36/38) and for MSTN 81.5% (31/38). The median survival time was 17.9 months in the DLL3 high expression group and 23 months in the DLL3 low expression group. Patients with a high expression of DLL3 showed a poorer prognosis than those with a low expression of DLL3 (HR=3.4; 95% CI, 1.34–8.6; p=0.01). Conclusion: The expression of DLL3, CTLA-4 and MSTN was not correlated with patients’ age, sex, smoking status, stage, and tumor metastasis. The fact that there was a higher expression of DLL3, CTLA-4, and MSTN in SCLC suggested that these molecules could be used as predictive biomarkers for SCLC.

Around the world, family caregivers are an important source of support for people with intellectual disability (ID) and for those with severe mental disorder (SMD), although the level of support can be influenced by the culture and government healthcare systems in each country. However, there is little evidence about the mental health and coping mechanisms of these caregivers in low-income countries. To address this need, we aimed to elicit whether there are potential links between coping style, mental health, and perceived burden experienced by this group, using a sample from a central Asian upper middle-income country. Methods: We recruited 120 participants, of which 60 were caregivers of people with ID and 60 of people with SMD. All participants were recruited from Ulaanbaatar, the capital city of Mongolia, Central Asia, and were asked to complete of the Depression, Anxiety and Stress Scale (DASS) and the Coping Orientation to Problems Experienced inventory scale (COPE). Multiple regression analyses were used to investigate associations between these measures. Results: We found that DASS scores were significantly higher among the sample of caregivers of individuals with ID than in those of SMD. Mental and behavioral disorders were associated with higher DASS scores in the sample of caregivers of those with SMD. Good coping styles, indicated by higher scores in the COPE, were associated with increased age in caregivers of individuals with ID. Conclusion: Although overall the carers of people with SMD appeared to have better active coping skills and better acceptance of the caring role, they demonstrated comparatively high levels of stress. This study was not registered.

Introduction In colorectal cancer, right-sided primary tumor location is associated with a worse prognosis compared to left-sided colon cancer. Objective: In this study, we compared clinical, pathological, oncological characteristics, and survival between cancers of the left and right colon. Methods: Patients who underwent curative resection for colon cancer were identified and retrospectively analyzed. Clinicopathological characteristics, overall survival, postoperative complications, and postoperative liver metastasis were compared between left- and right-sided tumors using the log-rank test and multivariable Cox proportional hazards regression. Results: A total of 108 patients with colon adenocarcinoma were included. There was no difference in overall survival (hazard ratio [HR] = 1.08, 95% confidence interval [CI]: 0.68–1.73, p = 0.72) between right- and left-sided primary tumors. Postoperative liver recurrence was noted in 24.1% of cases, and postoperative complications occurred in 6.5% of patients, without significant differences between groups. Higher body mass index (odds ratio [OR] = 2.31, 95% CI: 1.05–15.32, p = 0.031) and larger tumor size (OR = 5.32, 95% CI: 2.82–11.14, p = 0.001) were significantly associated with colon cancer risk. Additionally, a positive family history of cancer was significantly associated with decreased overall survival (HR = 2.44, 95% CI: 1.16–5.12, p = 0.018). Conclusion: Tumor localization was not associated with overall survival among colon cancer patients who underwent curative resection. However, a positive family history of cancer was associated with overall survival.

Background/Objectives: Virtual training is an innovative educational technology that offers students a more engaging and interactive experience compared to tradition-al classroom-based learning. This study aims to compare the effectiveness of tradition-al and virtual reality training methods in enhancing nursing students' knowledge and skills related to pneumonia care. Methods: A total of 120 nursing students were ran-domly assigned into a virtual reality group and a control group to study the pneumo-nia subject, comprising of 2 hours of theoretical lessons and 8 hours of hands-on train-ing. At the end of the course, the knowledge and skill scores were compared between the students in the virtual reality and traditional training groups using independent samples t-tests. Results: Students in the traditional training class scored higher in pneumonia-related knowledge compared to those in the virtual reality training group. In contrast, students participating in the virtual reality training group (mean score: 75.5, CI 72.1 to 79.0) demonstrated a higher score on a practical test aimed to assess nursing skills associated with pneumonia than those in the traditional training class (mean score: 87.3, CI 83.8 to 90.8). Conclusions: This study identified significant differences in the effectiveness of traditional and virtual reality training methods in nursing education related to pneumonia care. These findings suggest that traditional methods re-main effective for consolidating foundational knowledge, while virtual reality training enhances hands-on competencies.

Background: Informal caregiving for individuals with intellectual disabilities can involve sustained psychological and social demands. This study assessed caregiver burden and psychological distress among informal caregivers of individuals with intellectual disabilities in Mongolia and examined their associations with caregiver and care-recipient characteristics. Methods: This descriptive cross-sectional study included 642 informal caregivers recruited from primary health care centers and the National Center for Mental Health in Ulaanbaatar. Psychological distress was assessed with the 42-item Depression Anxiety Stress Scales (DASS-42), and caregiver burden with the Zarit Burden Interview (ZBI). Results: The mean ZBI score was 39.03 ± 14.68, and 48.9% of caregivers had moderate-to-severe or severe burden. Severe or extremely severe symptoms were observed in 25.9% of participants for depression, 49.5% for anxiety, and 15.2% for stress. ZBI scores correlated positively with depression (r = 0.537), anxiety (r = 0.519), and stress (r = 0.584) (all p < 0.001). In multivariable models, higher ZBI scores remained associated with higher depression (β = 0.313), anxiety (β = 0.306), and stress scores (β = 0.355) (all p < 0.001). Conclusions: Caregiver burden and psychological distress were common and closely associated in this sample. Routine assessment of caregiver mental health, together with caregiver-focused psychosocial and community support, should be considered in services for individuals with intellectual disabilities.