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Effectiveness of Interactive Digital Textbooks on Learning Outcomes Among Nursing Students: A Systematic Review and Meta-Analysis

Lu S, Li D, Jiang R, Chen J, Zakaria R, Mohamed Z

Nurse Educ, 2026 Oct 21.
PMID: 42906117 DOI: 10.1097/NNE.0000000000002326

BACKGROUND: Interactive digital textbooks (IDTs) combine multimedia, interactivity, embedded assessment, and immediate feedback within a unified learning resource. These features may support technology-enhanced, learner-centered nursing education.
OBJECTIVE: To determine whether IDTs improve nursing students' knowledge, skills, learning motivation, and competence compared with traditional or noninteractive educational approaches.
METHODS: This was a systematic review and meta-analysis. PubMed, MEDLINE, the Cochrane Library, Ovid MEDLINE, databases accessed through EBSCOhost, Scopus, Web of Science Core Collection, ScienceDirect, China National Knowledge Infrastructure, Wanfang Data, and China VIP Journal Database were searched from inception through August 1, 2026; reference lists were also screened. Standardized mean differences (SMD) with 95% confidence intervals (CIs) were calculated using random-effects models. Risk of bias was assessed with RoB 2 for randomized controlled trials and RoBANS for nonrandomized studies. Subgroup analyses were conducted by study design, and sensitivity analyses were performed by excluding outliers.
RESULTS: Eight studies (4 randomized controlled trials and 4 quasi-experimental studies; 579 participants) were included. IDTs improved knowledge (5 studies; SMD, 0.59; 95% CI 0.23-0.95), skills (4 studies; SMD, 0.73; 95% CI 0.19-1.27), and learning motivation or competence (6 studies; SMD, 1.00; 95% CI 0.45-1.55). Knowledge and motivation findings remained robust in sensitivity analyses, whereas the effect on skills was nonsignificant in the randomized controlled trial (RCT)-only analysis. Heterogeneity was moderate to high.
CONCLUSIONS: IDTs appear to improve knowledge acquisition and learning motivation in nursing education. Effects on skills and competence are promising but less certain because of heterogeneity, variation in outcome measures, and the limited number of randomized trials. Well-designed, adequately powered trials using standardized outcomes and longer follow-up are needed.
Fulltext Pictet-Spengler reaction-based biosynthetic machinery in fungi

Yan W, Ge HM, Wang G, Jiang N, Mei YN, Jiang R, et al.

Proc Natl Acad Sci U S A, 2014 Dec 23;111(51):18138-43.
PMID: 25425666 DOI: 10.1073/pnas.1417304111

The Pictet-Spengler (PS) reaction constructs plant alkaloids such as morphine and camptothecin, but it has not yet been noticed in the fungal kingdom. Here, a silent fungal Pictet-Spenglerase (FPS) gene of Chaetomium globosum 1C51 residing in Epinephelus drummondhayi guts is described and ascertained to be activable by 1-methyl-L-tryptophan (1-MT). The activated FPS expression enables the PS reaction between 1-MT and flavipin (fungal aldehyde) to form "unnatural" natural products with unprecedented skeletons, of which chaetoglines B and F are potently antibacterial with the latter inhibiting acetylcholinesterase. A gene-implied enzyme inhibition (GIEI) strategy has been introduced to address the key steps for PS product diversifications. In aggregation, the work designs and validates an innovative approach that can activate the PS reaction-based fungal biosynthetic machinery to produce unpredictable compounds of unusual and novel structure valuable for new biology and biomedicine.
Association of CYP24A1 with survival and drug resistance in clinical cancer patients: a meta-analysis

Zeng R, Li H, Jia L, Lee SH, Jiang R, Zhang Y, et al.

BMC Cancer, 2022 Dec 16;22(1):1317.
PMID: 36527000 DOI: 10.1186/s12885-022-10369-x

BACKGROUND: Acquired chemo-drug resistance constantly led to the failure of chemotherapy for malignant cancers, consequently causing cancer relapse. Hence, identifying the biomarker of drug resistance is vital to improve the treatment efficacy in cancer. The clinical prognostic value of CYP24A1 remains inconclusive, hence we aim to evaluate the association between CYP24A1 and the drug resistance in cancer patients through a meta-analysis approach.
METHOD: Relevant studies detecting the expression or SNP of CYP24A1 in cancer patients up till May 2022 were systematically searched in four common scientific databases including PubMed, EMBASE, Cochrane library and ISI Web of Science. The pooled hazard ratios (HRs) indicating the ratio of hazard rate of survival time between CYP24A1high population vs CYP24A1low population were calculated. The pooled HRs and odds ratios (ORs) with 95% confidence intervals (CIs) were used to explore the association between CYP24A1's expression or SNP with survival, metastasis, recurrence, and drug resistance in cancer patients.
RESULT: Fifteen studies were included in the meta-analysis after an initial screening according to the inclusion and exclusion criteria. There was a total of 3784 patients pooled from all the included studies. Results indicated that higher expression or SNP of CYP24A1 was significantly correlated with shorter survival time with pooled HRs (95% CI) of 1.21 (1.12, 1.31), metastasis with pooled ORs (95% CI) of 1.81 (1.11, 2.96), recurrence with pooled ORs (95% CI) of 2.14 (1.45, 3.18) and drug resistance with pooled HRs (95% CI) of 1.42 (1.17, 1.68). In the subgroup analysis, cancer type, treatment, ethnicity, and detection approach for CYP24A1 did not affect the significance of the association between CYP24A1 expression and poor prognosis.
CONCLUSION: Findings from our meta-analysis demonstrated that CYP24A1's expression or SNP was correlated with cancer progression and drug resistance. Therefore, CYP24A1 could be a potential molecular marker for cancer resistance.
Fulltext Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)1

Klionsky DJ, Abdel-Aziz AK, Abdelfatah S, Abdellatif M, Abdoli A, Abel S, et al.

Autophagy, 2021 Jan;17(1):1-382.
PMID: 33634751 DOI: 10.1080/15548627.2020.1797280

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field.