Purpose: This study aimed to investigate the awareness, current educational status, and educational requirements of the nursing students regarding virtual reality (VR) and augmented reality (AR). Methods: A total 307 nursing students were included in this study using an online survey. Questionnaires were made to investigate the awareness of VR and AR. The final scale consisted of thirteen items and its validity and reliability were verified. Among the 203 nursing institution, 162 institutions were surveyed regarding education for VR and AR. Results: Among the participants, 99.7% knew about VR and AR, 83.7% had direct experiences, and 17.3% had made relative purchases. The awareness of VR and AR was about 4.35±0.73 (maximum scale of 6). Most participants thought that it would be favorable to use VR and AR for educational purposes in classes once or twice a week. Of the 162 nursing institutions, 30 invested in related facilities, and 13 invested in education in the form of cultural studies, lectures, or programs. Conclusion: The awareness of VR and AR among nursing students was positive and showed need for future education adoption. However, the current educational infrastructure is lacking. Therefore, there is a need to develop relevant educational programs in the future.

This study aimed to identify predictors for distant metastatic behavior and build a related prognostic nomogram in breast cancer. A total of 1,181 patients with non-metastatic breast cancer between 2003 and 2011 were analyzed. To predict the probability of distant metastasis, a nomogram was constructed based on prognostic factors identified using a Cox proportional hazards model. The 7-year overall survival and 5-year post-progression survival of locoregional versus distant recurrence groups were 67.6% versus 39.1% (p=0.027) and 54.2% versus 33.5% (p=0.043), respectively. Patients who developed distant metastasis showed early and late mortality risk peaks within 3 and after 5 years of follow-up, respectively, but a broad and low risk increment was observed in other patients with locoregional relapse. In multivariate analysis of distant metastasis-free interval, age (≥ 45 years vs. < 45 years), molecular subtypes (luminal A vs. luminal B, human epidermal growth receptor 2, and triple negative), T category (T1 vs. T2-3 and T4), and N category (N0 vs. N1 and N2-3) were independently associated (p < 0.05 for all). Regarding the significant factors, a well-validated nomogram was established (concordance index, 0.812). The risk score level of patients with initial brain failure was higher than those of non-brain sites (p=0.029). The nomogram could be useful for predicting the individual probability of distant recurrence in breast cancer. In high-risk patients based on the risk scores, more aggressive systemic therapy and closer surveillance for metastatic failure should be considered.

Infiltration of CD8⁺ T cells and their spatial contexture, represented by immunophenotype, predict the prognosis and therapeutic response in breast cancer. However, a non-surgical method using radiomics to evaluate breast cancer immunophenotype has not been explored. Here, we assessed the CD8⁺ T cell-based immunophenotype in patients with breast cancer undergoing upfront surgery (n = 182). We extracted radiomic features from the four phases of dynamic contrast-enhanced magnetic resonance imaging, and randomly divided the patients into training (n = 137) and validation (n = 45) cohorts. For predicting the immunophenotypes, radiomic models (RMs) that combined the four phases demonstrated superior performance to those derived from a single phase. For discriminating the inflamed tumor from the non-inflamed tumor, the feature-based combination model from the whole tumor (RM-whole_FC) showed high performance in both training (area under the receiver operating characteristic curve [AUC] = 0.973) and validation cohorts (AUC = 0.985). Similarly, the feature-based combination model from the peripheral tumor (RM-peri_FC) discriminated between immune-desert and excluded tumors with high performance in both training (AUC = 0.993) and validation cohorts (AUC = 0.984). Both RM-whole_FC and RM-peri_FC demonstrated good to excellent performance for every molecular subtype. Furthermore, in patients who underwent neoadjuvant chemotherapy (n = 64), pre-treatment images showed that tumors exhibiting complete response to neoadjuvant chemotherapy had significantly higher scores from RM-whole_FC and lower scores from RM-peri_FC. Our RMs predicted the immunophenotype of breast cancer based on the spatial distribution of CD8⁺ T cells with high accuracy. This approach can be used to stratify patients non-invasively based on the status of the tumor-immune microenvironment.

Background: Plasma glucose levels might be associated with the severity of tumor hypoxia in patients with cancer. In our previous study, we found that chronic hyperglycemia significantly increased the risk of locoregional recurrence in patients with non‐small cell lung cancer treated with radical radiotherapy (RT). Here, we evaluated the association between plasma glucose levels in terms of hemoglobin A1c (HbA1c) and locoregional recurrence‐free survival in patients with limited‐stage small cell lung cancer treated with radical RT.Methods: We retrospectively analyzed the clinical data of 59 patients with small cell lung cancer. HbA1c levels were measured 1 week before the start of RT. Survival outcomes were analyzed according to HbA1c levels. Multivariable analysis was conducted to identify whether HbA1c level was a significant prognostic factor for survival.Results: The 1‐, 2‐, and 3‐year locoregional recurrence‐free survival rates were 90.9, 86.1, and 78.9%, respectively, in the low HbA1c group, and 45.1, 27.1, and 20.3%, respectively, in the high HbA1c group (p < 0.001). The 1‐, 2‐, and 3‐year distant metastasis‐free survival rates were 67.2, 57, and 57%, respectively, in the low HbA1c group, while it was 56.6, 24.9, and 24.9%, respectively, in the high HbA1c group (p = 0.024). HbA1c level remained a significant prognostic factor for locoregional recurrence‐free survival in the multivariable analysis (p = 0.010).Conclusions: Chronic hyperglycemia is a significant prognostic factor for locoregional recurrence‐free survival in patients with limited‐stage small cell lung cancer treated with radical RT. Routine monitoring of plasma glucose levels and aggressive glycemic control should be conducted to prevent locoregional recurrence.

Background: The level of hemoglobin A1c (HbA1c) might be associated with the severity of tumor hypoxia in patients with cancer. Here, we evaluated the association between the level of HbA1c and survival outcome in stage III non‐small cell lung cancer patients treated with radical radiotherapy.Methods: We retrospectively analysed the clinical data of 104 patients with lung cancer treated with radiotherapy. The HbA1c levels of all patients were checked 1 week before the start of radiotherapy. Survival outcomes were analysed according to the HbA1c level.Results: The 1‐, 2‐, and 3‐year locoregional recurrence‐free survival rates were 88.3%, 68.8%, and 63.0%, respectively, in the patient group with HbA1c levels ≤6% and 75.5%, 54.4%, and 41.8%, respectively, in the patient group with HbA1c levels >6% (p = 0.015). The HbA1c level remained a significant prognostic factor for locoregional recurrence‐free survival on multivariable analysis (hazard ratio = 2.014, 95% confidence interval = 1.088–3.726, p = 0.026).Conclusions: Pretreatment HbA1c level is a significant prognostic factor for locoregional recurrence‐free survival in patients with stage III non‐small cell lung cancer treated with radical radiotherapy. Routine monitoring of pretreatment HbA1c levels and aggressive glycemic control may be considered to prevent the development of locoregional recurrence in these patients.