Yan'an University

With the rapid digitalization of healthcare systems, nursing interns must safely and effectively navigate digital health technologies during clinical training. Digital health literacy (DHL) is essential for safe nursing practice, yet the mechanisms driving its development within authentic clinical learning environments remain poorly understood.

To assess DHL levels among nursing interns and examine how preceptor and departmental support fosters DHL via digital self-efficacy, technology acceptance, and clinical information-technology use.

A nationwide, multi-centre cross-sectional study.

Eleven undergraduate nursing institutions across China.

A total of 1593 undergraduate nursing interns who had completed at least four months of clinical practice.

Validated instruments assessed DHL, digital self-efficacy, technology acceptance, clinical information-technology use, and perceived preceptor and departmental support. Data analysis involved descriptive statistics, correlation analysis, and multiple linear regression. Structural equation modelling (SEM) with bias-corrected bootstrap estimation evaluated the direct and indirect pathways underlying the hypothesized sequential mechanism of DHL development.

Participants demonstrated a moderate-to-high DHL level (60.55 ± 8.87), with the privacy protection subscale scoring highest and the skills and application subscale scoring lowest. SEM revealed a clear sequential mechanism underlying DHL development. Preceptor and departmental support exerted a strong indirect effect on DHL (total indirect effect = 0.185, p < 0.001) by enhancing nursing interns' digital self-efficacy and technology acceptance, which sequentially promoted clinical information-technology use, ultimately leading to higher DHL scores.

DHL among nursing interns can be conceptualized as a practice-based clinical competence developed through a sequential mechanism involving psychological and behavioral engagement with digital technologies. Integrating educational support and confidence-building strategies into clinical internships is essential, as these factors indirectly foster DHL through enhanced digital self-efficacy, technology acceptance, and clinical information-technology use, preparing a digitally competent nursing workforce capable of navigating modern healthcare systems.

Silicon dioxide (SiO₂) has emerged as a cornerstone in the design of nano-luminescent materials owing to its exceptional chemical stability, structural tunability, and biocompatibility. This review systematically highlights the pivotal functions of SiO₂ in three domains: stability enhancement, structural regulation, and function expansion. As a physical barrier, silica effectively prevents water and oxygen-induced degradation, thereby markedly improving the chemical and photostability of sensitive emitters. As a structural matrix, its mesoporous frameworks and surface chemistry enable precise loading, spatial confinement, and integration of luminescent units, while the control of pore size, defect states, and interfacial interactions allows tailoring of optical properties and energy-transfer pathways. Furthermore, advanced architectures such as core-shell, Janus, and chiral structures extend the functional boundaries of SiO₂-based systems, unlocking opportunities in bioimaging, anti-counterfeiting, and smart sensing. Built on these functions, the review introduces six representative nano-luminescent materials based on silica hybrid systems (including hybrids with carbon quantum dots, inorganic quantum dots, upconversion nanoparticles, perovskites, metal nanoparticles, and organic fluorophores), and demonstrates how silica imparts stability, structural regulation, and multifunctionality for nano-luminescent materials. Finally, current challenges, such as scalable synthesis, stability under extreme environments, and potential biosafety risks, are critically discussed. We believe that a possible future direction is an integrated development strategy of "intelligent design-precise regulation-green optimization", offering theoretical and practical guidance for advancing nano-luminescent materials toward real-world applications in biomedicine, optoelectronics, and environmental monitoring.

Cold atmospheric plasma (CAP) has emerged as a promising non-thermal modality in cancer research due to its ability to induce selective cytotoxicity through reactive oxygen and nitrogen species. However, the limited penetration depth and instability of plasma-derived reactive species in complex biological environments remain major obstacles to its therapeutic application. In this study, we investigated whether exosomes derived from CAP-treated cancer cells (CAP-Exo) could serve as functional mediators to extend and amplify the anti-tumor effects of CAP. Using chronic myeloid leukemia K562 cells as a primary model, we demonstrate that CAP treatment induces pronounced oxidative stress, apoptosis, and sustained proliferative suppression. Importantly, exosomes isolated from CAP-treated cells exhibited enhanced anti-proliferative and pro-apoptotic activity in recipient cells compared to exosomes from untreated controls. To assess the broader applicability of this strategy, we further evaluated the effects of CAP and CAP-Exo in multiple solid tumor models, including breast, renal, and hepatocellular carcinoma cells, both in vitro and in vivo. CAP exposure consistently reduced cell viability across solid tumor cell lines, while CAP-Exo retained potent cytotoxic activity against breast cancer cells and significantly suppressed tumor growth in corresponding xenograft models without inducing systemic toxicity. Mechanistically, CAP-induced stress reprogrammed exosomal cargo, enabling the transfer of death-associated molecular signals to recipient tumor cells and thereby promoting apoptosis. Collectively, our findings indicate that CAP-modified exosomes represent a biologically active, cell-free approach that extends the anti-tumor effects of CAP treatment across both hematological malignancies and solid tumors. Rather than replacing existing therapeutic modalities, CAP-Exo may serve as a complementary strategy to enhance CAP-based cancer interventions and overcome current limitations associated with direct CAP application.