Background: Colorectal cancer poses a significant global health challenge, with high incidence and mortality rates. Neoadjuvant chemoradiotherapy (CRT) is standard for rectal adenocarcinoma to improve surgical outcomes and reduce recurrence, yet the overall treatment efficacy remains inadequate. This study investigates the effects of low-dose aspirin as an adjunct therapy during neoadjuvant CRT in rectal cancer patients.
Methods: This non-randomized controlled trial included 90 patients with histologically confirmed Stage II or III rectal adenocarcinoma, allocated into two arms (45 each) receiving standard neoadjuvant CRT with or without 100 mg of daily oral aspirin. Primary outcomes included pathological complete response (pCR) rates, while secondary outcomes encompassed tumor regression grade (TRG) and tumor down-staging. Safety was assessed by monitoring aspirin-related adverse events. Comparisons between groups for the primary outcome and secondary outcomes were performed using chi-square tests.
Results: The aspirin group exhibited a significantly higher pCR rate of 26.6% compared to 17.7% in the control group (P < 0.001). Down-staging analysis indicated favorable outcomes in the aspirin compared to the control arm (47% vs. 24%, P < 0.001). No significant adverse events related to aspirin were reported.
Conclusion: Low-dose aspirin enhances the efficacy of neoadjuvant chemoradiation in rectal cancer patients, leading to improved pCR and tumor down-staging with minimal toxicity. These findings support aspirin's potential as a cost-effective adjunct to standard treatment protocols, warranting further investigation in larger trials.
Background: Approximately 1,000,000 cases and 769,000 deaths from gastric cancer (GC) occurred in 2020, making it the fourth most prevalent reason for cancer-related fatalities. The objective of this study was to examine the use of radiation therapy (RT) and chemoradiotherapy (CRT) in GC using a quantitative and scientometric method.
Methods: A comprehensive search was conducted in the Scopus database for articles on RT and CRT in GC from 2014 to 2023. We utilized the VOSviewer tool for a scientometric analysis covering various aspects such as countries, institutions, authors, journals, references, and keywords.
Results: The study incorporated 15,036 articles related to the subject. China emerged as the top contributor, with the United States and Japan following. A significant positive correlation was found between the article output of countries on RT and CRT in GC and gross domestic product (GDP) and total wealth index, with correlation coefficients of 0.749 and 0.6921, respectively (P < 0.001). The forefront of institutional contribution was marked by the University of Texas MD Anderson Cancer Center. J.A. Ajani from the USA stands out as the most prolific author in this field, having published 112 articles. The leading journal was Frontiers in Oncology, and the most cited article in this domain was authored by Smyth, E.C., in 2020, in The Lancet. Author keywords revealed 6 clusters, with "Esophageal cancer" (655 mentions) and "Gastric cancer" (379 mentions) being the most prevalent.
Conclusion: This pioneering scientometric study provides a comprehensive overview of the current state of research on RT and CRT about GC, evaluating the scholarly output in this field over the past decade. It can be concluded that this research topic has gained significant attention since 2016. While international collaborations are taking place worldwide, there is a need for more support and the expansion of research on RT and CRT in GC, especially in less developed countries. This study provides support to healthcare practitioners, researchers, and surgical aides regarding the global outcomes of RT and CRT in GC investigations.
Background: Nursing students require high clinical competence to become proficient and effective nurses. This study aimed to enhance the clinical competence of nursing students through the integration of microlearning and spaced learning.
Methods: This action research was conducted from 2022 to 2023 in 3 consecutive groups at the School of Nursing, Lorestan University of Medical Sciences. Participants included nursing students, faculty members, specialist nurses, and novice nurses. The study utilized Elliott's action research model over 2 cycles. In the first cycle, semistructured interviews with stakeholders were conducted to describe the current situation. Based on the results, appropriate strategies for improving clinical competence were planned and implemented. After evaluation and feedback, strengths and weaknesses were identified. In the second cycle, a new plan was developed to address the identified weaknesses, implemented, and reevaluated.
Results: From the semistructured interviews, 4 main categories emerged: (1) lack of practical experience, (2) deficiencies in clinical education and guidance, (3) stress in clinical environments, and (4) gaps in educational programs. Actions in the first cycle included the integration of microlearning and spaced learning. The second cycle focused on improving feedback, utilizing electronic tools, increasing group feedback sessions, employing a learning management system, and conducting periodic evaluations. Results indicated that integrating these methods could enhance the clinical competence of nursing students.
Conclusion: Integrating modern educational methods such as microlearning and spaced learning can significantly improve nursing students' clinical skills and understanding. Future studies should explore these methods further, emphasizing multimedia, virtual tools, and continuous hands-on practice to enhance clinical education.
Background: Truncus arteriosus represents a complex congenital heart disease, and accurate diagnostic imaging should be followed to provide adequate treatment. Computerized tomography (CT) angiography has thus been identified as a valuable technique for diagnosing, assessing surgical procedures, and tracking post-operative results in patients with these conditions.
Methods: The databases PubMed, Embase, Cochrane Library, plus Google Scholar were searched for potential studies addressing diagnostic accuracy, planning prior to surgery, and follow-up after surgery. In this review, analysis was undertaken for data retrieved from several CT angiocardiography cases to demonstrate the benefits of the technique and its efficiency.
Results: CT angiocardiography is superior to conventional angiography in that it is non-invasive and has high-resolution three-dimensional imaging, which improves the diagnostic ability of truncus arteriosus and the assessment of associated anomalies. It enhances preoperative planning since it presents a highly detailed map of the human body, thus enabling the surgeon to map out the planned operations and, at the same time, anticipate any complications. This approach is valuable because postoperative evaluation with CT angiocardiography is used to determine the success of surgical operations as well as identify residual defects or complications that may occur in the future and which would lead to reduced success.
Conclusion: Through the use of CT angiocardiography, managing patients with truncus arteriosus has become easier owing to the high diagnostic precision provided by the technique, as well as the assistance in proper surgical planning and postoperative monitoring. Clinical Practice messages include a call to incorporate CT in Pre-operative & follow-up evaluation.
Background: Old age is one of the critical stages of human life, encompassing a significant portion of people's lives in society. During this period, the elderly face various challenges, such as health conditions. As one of the important sectors, the tourism industry has gained considerable popularity among the elderly for promoting health. Therefore, this review study was conducted to examine the role of tourism in the health status of the elderly.
Methods: This scoping review was conducted according to Arksey and O'Malley (2005). In this scoping review, a systematic search was conducted for studies with any type of design on the role, impact, and consequences of tourism on the elderly. The search covered studies in both Persian and English languages from 1984 to 2023 across databases and search engines-including PubMed, Scopus, Web of Science, IranMedex, IRANDOC, Google Scholar, MAGIRAN, and SID-using the keywords "tourism, old person, senior, aged, aging, elderly, older adults, old age" and their Persian equivalents.
Results: Out of 7454 studies identified in the initial search, 23 articles on aging and tourism were finally reviewed based on the inclusion criteria. The studies investigated the role and impact of tourism on health in 3 ways: mixed methods, quantitative, and qualitative. In qualitative studies, the experiences of elderly people with tourism were examined, while quantitative studies explored tourism's predictive role as an independent variable and its correlation with various dimensions of health. The results of the quantitative studies showed that tourism improved the physical health of the elderly. The mean scores for cognitive function, daily activities, and vitality were reported to be higher among elderly tourists compared to nontourists. Additionally, the quality of life and well-being scores of elderly individuals who engaged in tourism were significantly higher compared to those who did not. Tourism experiences for the elderly were often associated with better life satisfaction, a sense of peace, and purpose in life.
Conclusion: Based on the results, tourism can improve the health and quality of life of the elderly. Given the importance of tourism, it is recommended that the tourism industry and its marketing for the elderly be prioritized as a target group. Additionally, to promote the tourism industry, special attention should be given to the specific needs and welfare issues of the elderly.
Background: The Internet of Things (IoT) has introduced new possibilities for revolutionizing medical education and training. This study aimed to conduct a systematic mapping review of existing research to identify and map current advancements in IoT in medical education. The study sought to address key research questions regarding trends and activities in IoT development within this field.
Methods: The systematic mapping review explored the intersection of IoT and medical education by systematically collecting, categorizing, and synthesizing relevant studies. We conducted a keyword search in major online scientific databases, and 285 papers were initially retrieved from IEEE, PubMed, Scopus, and Web of Science. After removing duplicates, 204 unique papers were identified. A 2-stage selection process based on predefined criteria narrowed this down to 28 eligible papers. Data extraction from these studies highlighted trends in research development and geographical distribution.
Results: The analysis revealed that most publications on IoT systems in medical education were peer-reviewed journal papers (79%), with conference proceedings making up 21%. Thirteen countries contributed to the research, with the United States leading. The studies included pilot projects, laboratory experiments, and feasibility studies. IoT devices and sensors were applied in various areas, such as curriculum development, clinical skills training, patient simulation, telemedicine, and distance learning. While general medicine saw the most IoT applications, other medical disciplines also utilized these technologies.
Conclusion: Our findings have shed light on the transformative potential of wearable technology and IoT applications in enhancing educational outcomes and practices. The versatility of IoT devices and sensors across multiple domains within medical education highlights their capacity to revolutionize teaching, learning, research, and clinical practice. Our findings catalyze medical education leaders and policymakers to delve deeper into the possibilities offered by IoT, ultimately leading to improved educational experiences and outcomes.
Background: Many patients with amyotrophic lateral sclerosis (ALS) experience respiratory failure. The use of respiratory muscle training exercises can improve the respiratory function of these patients. This study aimed to evaluate the effect of inspiratory muscle training (IMT) on respiratory muscle function in ALS patients.
Methods: In the current randomized controlled clinical trial study, 22 patients were randomly divided into intervention (n = 11) and control groups (n = 11). In the control group, patients used only chest-opening training and diaphragm exercises. Patients in the intervention group used IMT in addition to controlled exercises (chest opening training and diaphragm exercises). Respiratory function by spirometry and monitoring of maximum inspiratory and expiratory pressure, functional capacity with a 6-minute walk test, and arterial blood gases were also assessed by ABG analysis at baseline and after 8 weeks. A comparative analysis of variables was performed with a student t-test, considering type 1 error (α = 0.05) using SPSS 27 software.
Results: The indexes included maximal inspiratory pressure (PImax) (P = 0.000) and maximal expiratory pressures PEmax (P = 0.002). The strength of breathing muscles index (S-index) (P = 0.002) had a significant increase before and after rehabilitation in both groups (P ˂ 0.05). In intergroup analysis, the only factor with a significant increase was PImax (P = 0.019).
Conclusion: The use of IMT, along with chest opening training and diaphragm exercises, can cause a relative improvement of the respiratory muscles' function indexes, especially PImax in ALS patients. More clinical trials are required.
Background: Memory is one of the most affected cognitive domains in patients with Bipolar I Disorder, even during periods of euthymia. This study aimed to investigate the relationship between certain clinical and demographic variables and the domains of memory function in euthymic bipolar I patients.
Methods: This cross-sectional study included 100 patients who were confirmed to be euthymic at the time of the research, as indicated by Hamilton Depression Rating Scale scores (HDRS <7) and Young Mania Rating Scale scores (YMRS <12). Recruitment was conducted between March 2021 and March 2022. Their demographic data were collected, and all participants were evaluated for psychiatric comorbidities using the Structured Clinical Interview for DSM-5 (SCID-5-CV). Memory function was assessed using the Wechsler Memory Scale-3rd edition (WMS-3). The correlation between memory function and demographic and clinical variables was analyzed.
Results: The Wechsler Memory Scale total score was significantly associated with the number of hospitalizations, education level, and the number of depressive episodes. Notably, each additional hospitalization (β = -21.70 ± 8.18) and depressive episode (β = -23.36 ± 6.86) corresponded to a marked reduction in memory performance. The regression model demonstrated a robust fit, with an R-square value of 0.68.
Conclusion: Memory function is significantly correlated with the number of hospitalizations, level of education, and the number of previous depressive episodes in euthymic Bipolar I patients. This study underscores the importance of these factors in understanding and preventing memory impairment in this patient group.
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