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AIM: This study aimed to evaluate the effects of blended learning on nursing students. The primary outcomes include knowledge and skills, and the secondary outcomes include critical thinking ability, mental health, blended learning design, and nursing students' attitudes toward blended learning. BACKGROUND: Blended learning combines the advantages of online learning and traditional face-to-face learning, and makes up for the disadvantages of simple online learning or traditional learning. The effects of blended learning on the knowledge, skills, critical thinking ability, and mental health of nursing students were unknown. DESIGN: Systematic review and meta-analysis. METHODS: The present systematic review and meta-analysis was applied according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. Publications were searched in PubMed, Web of Science, EMBASE, ERIC, CINAHL and the Cochrane's Library before February 2023. Two researchers independently retrieved articles and evaluated quality. The meta-analysis was performed using Stata 12.0 software according to PRISMA guidelines. The risk of bias in the selected studies was evaluated using the Revised Cochrane risk-of-bias tool for randomized trials. Heterogeneity was assessed by I2 and P statistics. Standardized mean difference (SMD) and 95% confidence intervals (CIs) were used as effective indicators. RESULTS: A total of 26 studies involving 2823 nursing students were included in the present study. The results showed that blended learning courses were designed based on learning theory. Blended learning was more effective on the knowledge (SMD = 0.73, 95%CI [0.37, 1.09]) and skills (SMD = 0.86, 95% CI [0.35, 1.37]) compared with non-blended learning for nursing students. Critical thinking ability improved significantly through BL (SMD = 2.23, 95% CI [0.85, 3.61]). In addition, blended learning had a positive impact on nursing students' mental health. Nursing students were very satisfied with blended learning. CONCLUSIONS: The results of this study indicated that blended learning had a positive impact on nursing students. In the future, the optimal ratio of online to offline learning in blended learning should also be explored.

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OBJECTIVES: This meta-analysis aimed to investigate the effects of telemedicine-based follow-up management on adults with obstructive sleep apnea. METHODS: Publications were searched in the Cochrane Library, PubMed, Scopus, Web of Science and Embase. Studies were selected according to the predefined screening criteria, and their qualities were assessed by the Revised Cochrane risk-of-bias tool for randomized trials. The statistical analyses were performed using Stata12.0 software. It was registered in PROSPERO with the number: CRD42021276414. RESULTS: A total of 33 articles with 8,689 participants were included. Telemedicine-based follow-up management improved average daily continuous positive airway pressure usage by 36 min (weighted mean difference:0.61;95% confidence interval: 0.39 to 0.83), and the percentage of days with continuous positive airway pressure usage more than four hours by 10.67% in obstructive sleep apnea patients. The meta-analysis of good continuous positive airway pressure compliance showed telemedicine-based follow-up management did not lead to good continuous positive airway pressure compliance (odds ratio: 1.13;95% confidence interval: 0.72 to 1.76). The pooled mean difference of sleep quality was 0.15 (standardized mean difference:0.15; 95% confidence interval: -0.03 to 0.32), and daytime sleepiness was -0.26 (weighted mean difference: -0.26;95% confidence interval: -0.79 to 0.28). The pooled mean difference of apnea hypopnea index was -0.53 (95% confidence interval: -3.58 to 2.51). As for the overall quality of life, the pooled mean difference was -0.25 (standardized mean difference: -0.25;95% confidence interval: -0.25 to 0.76). CONCLUSION: Telemedicine-based follow-up management was beneficial for continuous positive airway pressure compliance of obstructive sleep apnea patients within six months. However, it could not improve sleep quality, daytime sleepiness, the severity of obstructive sleep apnea, and quality of life in obstructive sleep apnea patients compared with traditional follow-up. Moreover, it was more cost-effective, but there was no consensus on whether it would increase the workload of medical staff.

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Flaxseed is a functional food because of its high content of alpha-linolenic acid, lignans, and dietary fiber. We hypothesized that flaxseed supplementation would improve cardiometabolic parameters in patients with type 2 diabetes mellitus (T2DM); however, clinical trials have shown conflicting results. Therefore, this systematic review and meta-analysis was conducted to determine the impact of flaxseed supplementation in patients with T2DM. Randomized controlled trials were systematically searched in PubMed, Web of Science, Scopus, Cochrane Library, and Embase until 25 March 2022. A total of 13 studies were included, and the results showed that flaxseed supplementation significantly reduced hemoglobin A1c (HbA1c) in participants with T2DM compared with the control group. In contrast, it had no effects on body weight, body mass index, blood pressure, fasting blood glucose (FBG), homeostatic model assessment for insulin resistance, quantitative insulin sensitivity check index, and lipid parameters. In the subgroup analyses, FBG was significantly reduced with supplementation of flaxseed in participants with baseline FBG ≥8.0 mmol/L or baseline HbA1c ≥7.0%. And a significant decrease in HbA1c in participants with baseline HbA1c ≥7.0% after flaxseed supplementation. In addition, subgroup analyses indicated that whole flaxseed supplementation significantly increased high-density lipoprotein cholesterol and reduced total cholesterol or low-density lipoprotein cholesterol in participants with T2DM. In conclusion, flaxseed supplementation significantly reduced HbA1c in participants with T2DM, especially those with poorly controlled blood sugar levels. However, larger scale studies with better designs are needed to confirm insignificant and/or ambiguous findings.

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BACKGROUND: Current clinical trials have had controversial results regarding the effects of oat consumption on blood pressure (BP) in adults. OBJECTIVE: The meta-analysis was conducted to systematically evaluate the effects of oat consumption on BP in adults. METHODS: Electronic databases including PubMed, Web of Science, Scopus, Cochrane Library, and Embase were searched until December 13, 2021 for eligible randomized controlled trials (RCTs). RCTs published in English and that explored the effects of oat consumption on BP in adults under matched total energy intake were included. Meta-analysis using a random-effects model was performed. The pooled effect size was expressed as mean difference and 95% CI. I2 statistics were used to quantify heterogeneity. The risk of bias was assessed using the Cochrane Risk-of-Bias Tool, version 2. RESULTS: Twenty-one RCTs involving 1,569 participants were included. The pooled results indicated that consuming oats reduced systolic blood pressure (SBP) significantly (mean difference = -2.82 mm Hg; 95% CI -4.72 to -0.93 mm Hg; P = .004). Subgroup analyses indicated that oat consumption reduced SBP significantly in hypertensive participants, or when compared with control group participants who consumed refined grains. No significant reduction in diastolic blood pressure (DBP) was observed after oat consumption (mean difference = -1.16 mm Hg; 95% CI -2.37 to 0.04 mm Hg; P = .060). However, the sensitivity analysis of DBP, removal of individual studies, or "leave one out meta-analysis," showed a significant reduction in DBP, suggesting that the pooled result in the main analysis was not robust. Subgroup analyses showed that oat consumption did significantly reduce DBP in participants with baseline BP in the prehypertensive range. Both SBP and DBP were significantly reduced when the dosage of oat consumption was ≥5 g/day ß-glucan, or the oat consumption duration was ≥8 weeks. CONCLUSIONS: Oat consumption is effective in reducing SBP levels, particularly in individuals whose baseline BP is in the hypertensive range or when compared with control group participants consuming refined grains at matched total energy intake.

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Lilium primulinum var. burmanicum (W. W. Smith) Stearn 1948 is an ornamental and medicinal plant that has an extremely limited distribution in Yunnan, China. Here, we obtained the complete plastome of L. primulinum var. burmanicum via next-generation sequencing, and conducted phylogenomic analyses with existing species from Lilium. The total length of L. primulinum var. burmanicum was 152,206 bp with a typical quadripartite structure. The whole plastome contained a pair of inverted repeats (IRa/IRb; 26,399 bp) which divided a large single-copy (LSC; 81,854 bp) and a small single-copy (SSC; 17,563 bp). The average GC content among the whole plastome sequence and the LSC, SSC, and IR regions were 37%, 34.8%, 30.6%, and 42.5%, respectively. There were 134 genes detected from the whole plastome sequence, including 87 protein-coding genes, 39 tRNAs, and 8 rRNAs. Phylogenetic analyses using maximum likelihood showed congruent results that L. primulinum var. burmanicum together with L. primulinum var. ochraceum formed a single branch. These results demonstrate a close relationship between these variation species. The newly characterized chloroplast genome presented here will provide essential data for further phylogenomic analyses of the intraspecific relationship among Lilium species and for conservation genetics research of L. primulinum var. burmanicum.

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Traditional heat transfer analysis has been adopted to predict the damage in a tunnel under fire without considering the effect of concrete spalling, which leads to underestimation of the fire damage of concrete. However, accounting for the spalling effect of concrete under high temperature in an analytical heat transfer model is difficult because of the complexity of the spalling mechanism. This study aims to establish an analytical model to estimate the influence of concrete spalling on the fire-damage depth prediction. To overcome this challenge, first, a series of fire tests were conducted in a unidirectional heating system. The spalling phenomenon and spalling characteristics were observed. Based on the experimental test results, the moisture content of concrete is one of the key factors of spalling. Obvious layered spalling characteristics of concrete samples without drying could be observed under the unidirectional heat conduction system. The critical temperature of spalling is 600 °C, and the thickness of the spalling layer is 2 cm~2.5 cm. These two parameters are critical spalling conditions. Second, a multilayer model for the heat transfer analysis considering the spalling effect of tunnel lining under fire was proposed. By using Laplace transform and the series solving method for ordinary differential equations, the time-dependent temperature and stress fields of concrete lining during tunnel fire could be obtained, which are the basis of damage evolution. The analytical results agreed with the experimental data. The spalling depth of tunnel lining related to the temperature rise of tunnel fire could be predicted by using the proposed analytical model. The results of this research can be used to provide a better damage evaluation of tunnel lining under fire.

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OBJECTIVES: The purpose of this study is to summarize the evidence for the association between snoring and hypertension and the effect of snoring on hypertension in men and/or women. METHODS: We searched the articles in the Cochrane Library, PubMed, Scopus, Web of Science and Embase published up to 12 November 2020 to evaluate the association between snoring and hypertension. Studies were selected according to the predefined screening criteria and their qualities were assessed by Newcastle-Ottawa Quality Evaluation Scale. The odds ratio and 95% confidence interval were used as effective indicators. It was registered in PROSPERO with the number: CRD42021224912. RESULTS: According to the inclusion/exclusion criteria, 11 studies including eight prospective cohort studies and three cross-sectional studies were included. The results showed that compared with non-snoring participants, snoring significantly increased the risk of hypertension in both men and women [odds ratio (OR) = 1.32, 95% confidence interval (CI), 1.23-1.42; men: odds ratio (OR) = 1.32; 95% confidence interval (CI), 1.18-1.49; women: odds ratio (OR) = 1.26; 95% confidence interval (CI), 1.14-1.40]. Besides, the risk of hypertension was significantly increased when the snoring frequency was ≥4 nights/week [frequency≥4 nights/week: odds ratio (OR) = 1.42; 95% confidence interval (CI), 1.21-1.66; 4 nights/week >frequency>0: odds ratio (OR) = 1.23; 95% confidence interval (CI),1.13-1.34]. CONCLUSIONS: Snoring is considered as an independent predictor of hypertension in both men and women, which may play a role in the prevention and control of hypertension. People who snore frequently should pay close attention to their blood pressure levels to prevent hypertension.

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OBJECTIVE: The purpose of this study is to evaluate the effects of combined aerobic and resistance exercise on blood pressure (BP) in postmenopausal women. The results of this study will provide an effective means for postmenopausal women to control BP and reduce the morbidity and mortality of cardiovascular disease (CVD). METHODS: Eligible studies were searched in five electronic databases until November 2020, and 11 randomized controlled trials that met the inclusion criteria were included in this systematic review and meta-analysis. The random-effects model was used to calculate overall effect sizes of weighted mean differences (WMD) and 95% confidence interval (CI). This study was registered in PROSPERO with the registration number: CRD42021225546. RESULTS: Compared with the control group, the aerobic combined resistance exercise significantly decreased the systolic blood pressure (SBP) and diastolic blood pressure (DBP) by 0.81 mmHg (95% CI, -1.34 to -0.28) and 0.62 mmHg (95% CI, -1.11 to -0.14), respectively. The results of the meta-analysis also indicated that a significant reduction in brachial-to-ankle pulse wave velocity (baPWV) of - 1.18 m/s (95% CI, -1.81 to -0.56) and heart rate (HR) of -0.22 beats/min (95% CI: -0.42 to -0.02) after combined aerobic and resistance exercise intervention. Subgroup analysis showed that postmenopausal women ≥60 years of age who were overweight or had a normal baseline BP were more sensitive to the combined aerobic and resistance exercise. When combined aerobic and resistance exercise frequency < 3 times/week, weekly exercise time ≥ 150 min, or the duration of exercise lasted for 12 weeks, the SBP and DBP of postmenopausal women could be reduced more effectively. CONCLUSIONS: The present study indicates that combined aerobic and resistance exercise can significantly reduce BP in postmenopausal women. Accordingly, combined aerobic and resistance exercise may be an effective way to prevent and manage hypertension in postmenopausal women.

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BACKGROUND: Previous clinical studies have shown controversial results regarding the effect of inorganic nitrate supplementation on blood pressure (BP) in older individuals. We performed this systematic review and meta-analysis to assess the effect of inorganic nitrate on BP in older adults. METHODS: Eligible studies were searched in Cochrane Library, PubMed, Scopus, Web of Science, and Embase. Randomized controlled trials which evaluated the effect of inorganic nitrate consumption on BP in older adults were recruited. The random-effect model was used to calculate the pooled effect sizes. RESULTS: 22 studies were included in this meta-analysis. Overall, inorganic nitrate consumption significantly reduced systolic blood pressure (SBP) by -3.90 mmHg (95% confidence interval: -5.23 to -2.57; P < 0.001) and diastolic blood pressure (DBP) by -2.62 mmHg (95% confidence interval: -3.86 to -1.37; P < 0.005) comparing with the control group. Subgroup analysis showed that the BP was significantly reduced when participants' age≥65, BMI>30, or baseline BP in prehypertension stage. And both SBP and DBP decreased significantly after acute nitrate supplementation of a single dose (<1 day) or more than 1-week. However, participants with hypertension at baseline were not associated with significant changes in both SBP and DBP. Subgroup analysis of measurement methods showed that only the resting BP group showed a significant reduction in SBP and DBP, compared with the 24-h ambulatory BP monitoring (ABPM) group and daily home BP measurement group. CONCLUSION: These results demonstrate that consuming inorganic nitrate can significantly reduce SBP and DBP in older adults, especially in whose age ≥ 65, BMI＞30, or baseline BP in prehypertension stage.

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